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Wang S, Gong Y, Huang K, Huang J. Peripheral ulcerative keratitis secondary to tuberculosis: A case report and literature review. Medicine (Baltimore) 2024; 103:e39482. [PMID: 39213216 PMCID: PMC11365642 DOI: 10.1097/md.0000000000039482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
RATIONALE Compared with intraocular tuberculosis, ocular tuberculosis with ocular surface involvement is rare. Corneal involvement in ocular tuberculosis may include interstitial keratitis or peripheral ulcerative keratitis. We report a case of peripheral ulcerative keratitis directly caused by tuberculosis. PATIENT CONCERNS A 20-year-old man complained of vision loss and pain in the left eye that had lasted for 1 week. A slit lamp examination of the left eye showed a corneal epithelial defect, interstitial corneal edema, and a white irregular infiltrative lesion and ulcer (with the dimension of 2 × 2.5 mm) in the inferior temporal region. DIAGNOSES The corneal ulcer was scraped, and the Mycobacterium tuberculosis deoxyribonucleic acid polymerase chain reaction was positive. INTERVENTIONS AND OUTCOMES After a month of oral antituberculosis treatment, the corneal ulcer resolved, and the intraocular inflammation improved. LESSONS Peripheral ulcerative keratitis secondary to tuberculosis can be directly caused by M tuberculosis.
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Affiliation(s)
- Shuang Wang
- Ophthalmology Department, Chengdu Third People’s Hospital, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Yajie Gong
- Ophthalmology Department, Chengdu Third People’s Hospital, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Keke Huang
- Ophthalmology Department, Chengdu Third People’s Hospital, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Jun Huang
- Department of Microbiology, Chengdu Third People’s Hospital, Southwest Jiaotong University, Chengdu, Sichuan, China
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2
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Hernández-Bazán S, Mata-Espinosa D, Ramos-Espinosa O, Lozano-Ordaz V, Barrios-Payán J, López-Casillas F, Hernández-Pando R. Adenoviral Vector Codifying for TNF as a Co-Adjuvant Therapy against Multi-Drug-Resistant Tuberculosis. Microorganisms 2023; 11:2934. [PMID: 38138078 PMCID: PMC10745769 DOI: 10.3390/microorganisms11122934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
Mycobacterium tuberculosis is the main causal agent of pulmonary tuberculosis (TB); the treatment of this disease is long and involves a mix of at least four different antibiotics that frequently lead to abandonment, favoring the surge of drug-resistant mycobacteria (MDR-TB), whose treatment becomes more aggressive, being longer and more toxic. Thus, the search for novel strategies for treatment that improves time or efficiency is of relevance. In this work, we used a murine model of pulmonary TB produced by the MDR-TB strain to test the efficiency of gene therapy with adenoviral vectors codifying TNF (AdTNF), a pro-inflammatory cytokine that has protective functions in TB by inducing apoptosis, granuloma formation and expression of other Th1-like cytokines. When compared to the control group that received an adenoviral vector that codifies for the green fluorescent protein (AdGFP), a single dose of AdTNF at the chronic active stage of the disease produced total survival, decreasing bacterial load and tissue damage (pneumonia), which correlated with an increase in cells expressing IFN-γ, iNOS and TNF in pneumonic areas and larger granulomas that efficiently contain and eliminate mycobacteria. Second-line antibiotic treatment against MDR-TB plus AdTNF gene therapy reduced bacterial load faster within a week of treatment compared to empty vector plus antibiotics or antibiotics alone, suggesting that AdTNF is a new potential type of treatment against MDR-TB that can shorten second-line chemotherapy but which requires further experimentation in other animal models (non-human primates) that develop a more similar disease to human pulmonary TB.
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Affiliation(s)
- Sujhey Hernández-Bazán
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (S.H.-B.); (D.M.-E.); (O.R.-E.); (V.L.-O.); (J.B.-P.)
| | - Dulce Mata-Espinosa
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (S.H.-B.); (D.M.-E.); (O.R.-E.); (V.L.-O.); (J.B.-P.)
| | - Octavio Ramos-Espinosa
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (S.H.-B.); (D.M.-E.); (O.R.-E.); (V.L.-O.); (J.B.-P.)
| | - Vasti Lozano-Ordaz
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (S.H.-B.); (D.M.-E.); (O.R.-E.); (V.L.-O.); (J.B.-P.)
| | - Jorge Barrios-Payán
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (S.H.-B.); (D.M.-E.); (O.R.-E.); (V.L.-O.); (J.B.-P.)
| | - Fernando López-Casillas
- Departamento de Biología Celular, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City 14080, Mexico;
| | - Rogelio Hernández-Pando
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico; (S.H.-B.); (D.M.-E.); (O.R.-E.); (V.L.-O.); (J.B.-P.)
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3
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Jahnich N, Arkwright PD. Regional risk of tuberculosis and viral hepatitis with tumor necrosis factor-alpha inhibitor treatment: A systematic review. Front Pharmacol 2023; 14:1046306. [PMID: 36744250 PMCID: PMC9894886 DOI: 10.3389/fphar.2023.1046306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
Background: TNFα inhibitors are regularly used to treat autoimmune diseases. Tuberculosis (TB) and viral hepatitis B are considered potential infectious complications, and screening and surveillance are therefore recommended. Current guidelines do not take into account regional differences in endemicity of these infections. Methods: A systematic literature review of TB and viral hepatitis in patients receiving TNFα-inhibitors was performed, searching in PubMed, Embase, MEDLINE and Web of Science databases. Studies were selected against predefined eligibility criteria and assessed using the Newcastle-Ottawa scale. The number of TB and viral hepatitis cases/1,000 TNFα-inhibitor patients were evaluated, and regional variation compared. Results: 105 observational studies involving over 140,000 patients were included. Overall, 1% of patients developed TB or viral hepatitis B. TB cases/1,000 TNFα-inhibitor patients were 4-fold higher in Asia, Africa, and South America than in Europe, North America, and Australasia where only 0%-0.4% of patients developed TB. Hepatitis B cases/1,000 patients were over 15-fold higher in countries with high prevalence (China, Taiwan, South Korea, Thailand) compared with low prevalence (p < 0.00001) where only 0.4% of patients developed hepatitis B. Only three of 143 patients developed viral hepatitis C, and there was insufficient data to allow regional sub-analysis. Conclusion: TB and viral hepatitis B infections in patients treated with TNFα inhibitors are largely confined to countries with high prevalence of these infections. As only 1/2,500 patients in low prevalence countries treated with TNFα inhibitors develop TB or viral hepatitis B, we suggest an individualized, risk-based approach, rather than universal screening for all patients.
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Affiliation(s)
| | - Peter D. Arkwright
- Lydia Becker Institute of Immunology and Inflammation, Manchester Incubator Building, University of Manchester, Manchester, United Kingdom
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Larussa T, Basile A, Palleria C, Iannelli C, Vero A, Giubilei L, De Sarro C, Suraci E, Marasco R, Imeneo M, Russo E, Abenavoli L, De Sarro G, Luzza F. Real-life burden of adverse reactions to biological therapy in inflammatory bowel disease: a single-centre prospective case series. Med Pharm Rep 2021; 94:289-297. [PMID: 34430850 DOI: 10.15386/mpr-1897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/20/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background/aim Biologics represent a key therapeutic option in inflammatory bowel disease (IBD), but are associated with several side effects. Post-marketing surveillance, through a spontaneous adverse drug reactions (ADRs) monitoring system, is essential to assess the safety profile of biologics. The aim of the study was to prospectively evaluate the occurrence of ADRs in IBD patients treated with biologics from a single centre in Southern Italy. Methods Data from patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) who underwent biological therapy were prospectively collected. ADRs were classified according to the Medical Dictionary for Regulatory Activities (MedDRA®). Results Overall, 68 (54% male, 68% with UC and 32% with CD) biologic-naïve IBD patients underwent biological therapy. Mean follow-up was 11.7 ± 6.2 months. As a results of switches, for 68 patients we obtained 96 biologic prescriptions. Overall, 45 ADRs occurred in 36 (53%) patients, distributed as follows (ADRs/prescriptions): 19/37 with IFX-Remicade, 5/12 with IFX-Remsima, 8/9 with GOL, 11/26 with ADA, and 2/12 with VDZ. Mild ADRs were 29 (64%), moderate 15 (34%) and 1 (2%) severe. General disorders and administration related reactions were the most frequent ADRs (35%), followed by skin and subcutaneous tissue disorders (20%), infections (15%), musculoskeletal (11%), respiratory (6%) blood (4%), gastrointestinal (4%), and vascular disorders (2%). In 9 cases (20%) the ADRs resulted in definitive discontinuation of biologic therapy. Conclusion In a prospective cohort of IBD patients, more than half experienced ADRs during biologic therapy. General disorders and administration related reactions were the most common ADRs, while infections were less common and rarely led to discontinuation of therapy. Findings underline the importance of surveillance in management of IBD patients during biologic therapy and implementing safety protocols with data from real-life settings.
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Affiliation(s)
- Tiziana Larussa
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Antonio Basile
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Caterina Palleria
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Chiara Iannelli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Ada Vero
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Lidia Giubilei
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Caterina De Sarro
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Evelina Suraci
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Raffaella Marasco
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Maria Imeneo
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Emilio Russo
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | | | - Francesco Luzza
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
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Davis JS, Ferreira D, Paige E, Gedye C, Boyle M. Infectious Complications of Biological and Small Molecule Targeted Immunomodulatory Therapies. Clin Microbiol Rev 2020; 33:e00035-19. [PMID: 32522746 PMCID: PMC7289788 DOI: 10.1128/cmr.00035-19] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The past 2 decades have seen a revolution in our approach to therapeutic immunosuppression. We have moved from relying on broadly active traditional medications, such as prednisolone or methotrexate, toward more specific agents that often target a single receptor, cytokine, or cell type, using monoclonal antibodies, fusion proteins, or targeted small molecules. This change has transformed the treatment of many conditions, including rheumatoid arthritis, cancers, asthma, and inflammatory bowel disease, but along with the benefits have come risks. Contrary to the hope that these more specific agents would have minimal and predictable infectious sequelae, infectious complications have emerged as a major stumbling block for many of these agents. Furthermore, the growing number and complexity of available biologic agents makes it difficult for clinicians to maintain current knowledge, and most review articles focus on a particular target disease or class of agent. In this article, we review the current state of knowledge about infectious complications of biologic and small molecule immunomodulatory agents, aiming to create a single resource relevant to a broad range of clinicians and researchers. For each of 19 classes of agent, we discuss the mechanism of action, the risk and types of infectious complications, and recommendations for prevention of infection.
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Affiliation(s)
- Joshua S Davis
- Department of Infectious Diseases and Immunology, John Hunter Hospital, Newcastle, NSW, Australia
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, NT, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - David Ferreira
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Emma Paige
- Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC, Australia
| | - Craig Gedye
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Oncology, Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Michael Boyle
- Department of Infectious Diseases and Immunology, John Hunter Hospital, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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6
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Autoimmune keratitis in mycobacterium tuberculosis. J Curr Ophthalmol 2018; 30:381-383. [PMID: 30555976 PMCID: PMC6276618 DOI: 10.1016/j.joco.2018.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 03/14/2018] [Accepted: 03/19/2018] [Indexed: 11/22/2022] Open
Abstract
Purpose To report a case of autoimmune keratitis in a patient with mycobacterium tuberculosis (MBT). Methods An 84-year-old male with pulmonary tuberculosis (TB) was admitted with chronic, non-healing bilateral ulcerations of the inferior peripheral cornea associated with stromal and subconjunctival nodules. Results Clinical examination revealed circumscribed peripheral corneal ulceration with whitish nodules in adjacent stromal and subconjunctival tissue. Microbiological cultures of the corneal tissue were negative for MBT and other microbial pathogens; however, enzyme-linked immunosorbent assay (ELISA) of blood and corneal samples showed significantly elevated levels of IgM and IgA against MBT. In addition to systemic anti-tuberculosis therapy, the patient was treated topically with Polyspectran® eye drops, Dexamethasone eye drops, and Bepanthen® ointment, for 2 weeks. Both eyes showed dramatic improvement after 2 weeks. Conclusion The present report demonstrates that MBT is able to initiate delayed autoimmune response within the corneal tissue during an intensive phase of anti-tuberculosis treatment.
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Chen YH, de Carvalho HM, Kalyoncu U, Llamado LJQ, Solano G, Pedersen R, Lukina G, Lichauco JJ, Vasilescu RS. Tuberculosis and viral hepatitis infection in Eastern Europe, Asia, and Latin America: impact of tumor necrosis factor-α inhibitors in clinical practice. Biologics 2018; 12:1-9. [PMID: 29391775 PMCID: PMC5769557 DOI: 10.2147/btt.s148606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tumor necrosis factor-α (TNF-α) inhibitors are increasingly becoming the standard of care for treating a number of inflammatory diseases. However, treatment with TNF-α inhibitors carries an inherent risk of compromising the immune system, resulting in an increased susceptibility to infections and malignancies. This increased risk of infection is of particular concern in Asia, Eastern Europe, and Latin America where tuberculosis (TB) and viral hepatitis are endemic. In this brief review, we examine the literature and review the impact of TNF-α inhibitors on the incidence and the reactivation of latent disease with respect to TB, hepatitis C infection, and hepatitis B infection. Our findings show that TNF-α inhibitors are generally safe, if used with caution. Patients should be screened prior to the initiation of TNF-α inhibitor treatment and given prophylactic treatment if needed. In addition, patients should be monitored during treatment with TNF-α inhibitors and after treatment has stopped to ensure that infections, if detected, are treated promptly and effectively. Our analysis is consistent with other reports and guidelines.
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Affiliation(s)
- Yi-Hsing Chen
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung City, Taiwan
| | | | - Umut Kalyoncu
- Department of Internal Medicine, Faculty of Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | | | | | | | | | - Juan J Lichauco
- Section of Rheumatology, Department of Medicine, St. Luke's Medical Center, Quezon City, Manila, Philippines
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Desai RJ, Thaler KJ, Mahlknecht P, Gartlehner G, McDonagh MS, Mesgarpour B, Mazinanian A, Glechner A, Gopalakrishnan C, Hansen RA. Comparative Risk of Harm Associated With the Use of Targeted Immunomodulators: A Systematic Review. Arthritis Care Res (Hoboken) 2017; 68:1078-88. [PMID: 26663412 DOI: 10.1002/acr.22815] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To systematically compare the risk of adverse events (AEs) for 13 targeted immunomodulators (TIMs) indicated for ankylosing spondylitis (AS), inflammatory bowel diseases, juvenile idiopathic arthritis, plaque psoriasis, psoriatic arthritis (PsA), or rheumatoid arthritis (RA). METHODS We searched electronic databases through July 2015 to retrieve randomized controlled trials (RCTs) and observational studies comparing AEs between 2 or more TIMs head-to-head. We reported on the following outcomes: number of AEs, discontinuation due to AEs, serious AEs, mortality, serious infections, tuberculosis, herpes zoster, and malignancies. We qualitatively synthesized the literature and conducted random-effects meta-analyses if 3 or more studies provided data for an outcome. RESULTS Ten head-to-head RCTs and 51 observational studies were included in this systematic review. A majority of the studies (70%) were conducted in RA patients. Risk of treatment discontinuation due to AEs was higher with infliximab than with adalimumab or etanercept in RA, PsA, and AS. A higher risk for serious infections was noted with infliximab than with abatacept, adalimumab, or etanercept in RA. Risk for treatment discontinuation due to AEs, serious infections, and tuberculosis was lower with etanercept than with adalimumab in RA. Limited evidence suggested no comparative differences in risk for mortality, malignancies, and herpes zoster for adalimumab, etanercept, and infliximab in RA. CONCLUSION Important differences were noted in the safety profile of TIMs in RA, generally favoring abatacept, adalimumab, and etanercept over infliximab. Head-to-head comparative evidence for other TIMs and non-RA populations was insufficient to draw conclusions for most of the safety outcomes.
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Affiliation(s)
- Rishi J Desai
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Gerald Gartlehner
- Danube University, Krems, Austria, and RTI International, Research Triangle Park, North Carolina
| | - Marian S McDonagh
- Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon
| | - Bita Mesgarpour
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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9
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Vandewoestyne S, Zabraniecki L, Jamard B, Cestac P, Cantagrel A, Civade E. Impact of urine dipstick abnormalities in patients on biotherapies. Joint Bone Spine 2017; 84:239-240. [DOI: 10.1016/j.jbspin.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 10/21/2022]
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10
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Bryant PA, Baddley JW. Opportunistic Infections in Biological Therapy, Risk and Prevention. Rheum Dis Clin North Am 2017; 43:27-41. [DOI: 10.1016/j.rdc.2016.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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11
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Choi CH, Song ID, Kim YH, Koo JS, Kim YS, Kim JS, Kim N, Kim ES, Kim JH, Kim JW, Kim TO, Kim HS, Kim HJ, Park YS, Park DI, Park SJ, Song HJ, Shin SJ, Yang SK, Ye BD, Lee KM, Lee BI, Lee SY, Lee CK, Im JP, Jang BI, Jeon TJ, Cho YK, Chang SK, Jeon SR, Jung SA, Jeen YT, Cha JM, Han DS, Kim WH. Efficacy and Safety of Infliximab Therapy and Predictors of Response in Korean Patients with Crohn's Disease: A Nationwide, Multicenter Study. Yonsei Med J 2016; 57:1376-85. [PMID: 27593865 PMCID: PMC5011269 DOI: 10.3349/ymj.2016.57.6.1376] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 03/05/2016] [Accepted: 04/12/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Infliximab is currently used for the treatment of active Crohn's disease (CD). We aimed to assess the efficacy and safety of infliximab therapy and to determine the predictors of response in Korean patients with CD. MATERIALS AND METHODS A total of 317 patients who received at least one infliximab infusion for active luminal CD (n=198) and fistulizing CD (n=86) or both (n=33) were reviewed retrospectively in 29 Korean referral centers. Clinical outcomes of induction and maintenance therapy with infliximab, predictors of response, and adverse events were evaluated. RESULTS In patients with luminal CD, the rates of clinical response and remission at week 14 were 89.2% and 60.0%, respectively. Male gender and isolated colonic disease were associated with higher remission rates at week 14. In week-14 responders, the probabilities of sustained response and remission were 96.2% and 93.3% at week 30 and 88.0% and 77.0% at week 54, respectively. In patients with fistulizing CD, clinical response and remission were observed in 85.0% and 56.2% of patients, respectively, at week 14. In week-14 responders, the probabilities of sustained response and remission were 94.0% and 97.1%, respectively, at both week 30 and week 54. Thirty-nine patients (12.3%) experienced adverse events related to infliximab. Serious adverse events developed in 19 (6.0%) patients including seven cases of active pulmonary tuberculosis. CONCLUSION Infliximab induction and maintenance therapy are effective and well tolerable in Korean patients with luminal and fistulizing CD. However, clinicians must be aware of the risk of rare yet critical adverse events.
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Affiliation(s)
- Chang Hwan Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Do Song
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Ho Kim
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ja Seol Koo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - You Sun Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Joo Sung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Soo Kim
- Department of Internal Medicine, Kyungpook National University Graduate School of Medicine, Daegu, Korea
| | - Jae Hak Kim
- Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea
| | - Ji Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Hyun Soo Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyo Jong Kim
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Young Sook Park
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Joo Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sung Jae Shin
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Suk Kyun Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, University of Ulsan College of Medicine, Seoul, Korea
| | - Kang Moon Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Bo In Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sun Young Lee
- Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Chang Kyun Lee
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Ik Jang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Tae Joo Jeon
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Yu Kyung Cho
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sae Kyung Chang
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seong Ran Jeon
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung Ae Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dong Soo Han
- Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea
| | - Won Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Lee JW, Choi CH, Park JH, Kim JW, Kang SB, Koo JS, Kim YH, Kim YS, Joo YE, Chang SK. Clinical features of active tuberculosis that developed during anti-tumor necrosis factor therapy in patients with inflammatory bowel disease. Intest Res 2016; 14:146-51. [PMID: 27175115 PMCID: PMC4863048 DOI: 10.5217/ir.2016.14.2.146] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 03/20/2016] [Accepted: 03/21/2016] [Indexed: 12/27/2022] Open
Abstract
Background/Aims Anti-tumor necrosis factor (TNF) therapy for active ulcerative colitis (UC) and Crohn's disease (CD) is associated with increased risks of tuberculosis (TB) infection. We analyzed the incidence and clinical features of Korean patients with inflammatory bowel disease (IBD) who developed active TB during anti-TNF therapy. Methods Ten cases of active TB developed in patients treated with infliximab (n=592) or adalimumab (n=229) for UC (n=160) or CD (n=661) were reviewed. We analyzed demographics, interval between start of anti-TNF therapy and active TB development, tests for latent TB infection (LTBI), concomitant medications, and the details of diagnosis and treatments for TB. Results The incidence of active TB was 1.2% (10/821): 1.5% (9/592) and 0.4% (1/229) in patients receiving infliximab and adalimumab, respectively. The median time to the development of active TB after initiation of anti-TNF therapy was three months (range: 2–36). Three patients had past histories of treatment for TB. Positive findings in a TB skin test (TST) and/or interferon gamma releasing assay (IGRA) were observed in three patients, and two of them received anti-TB prophylaxis. Two patients were negative by both TST and IGRA. The most common site of active TB was the lungs, and the active TB was cured in all patients. Conclusions Active TB can develop during anti-TNF therapy in IBD patients without LTBI, and even in those with histories of TB treatment or LTBI prophylaxis. Physicians should be aware of the potential for TB development during anti-TNF therapy, especially in countries with a high prevalence of TB.
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Affiliation(s)
- Jang Wook Lee
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Chang Hwan Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji Hoon Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong Wook Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang Bum Kang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Daejeon, Korea
| | - Ja Seol Koo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Ho Kim
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - You Sun Kim
- Department of Internal Medicine, Inje University College of Medicine, Seoul, Korea
| | - Young Eun Joo
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sae Kyung Chang
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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13
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Brocq O, Acquacalda E, Berthier F, Albert C, Bolla G, Millasseau E, Destombe C, Azulay J, Asquier C, Florent A, Le Seaux S, Euller-Ziegler L. Influenza and pneumococcal vaccine coverage in 584 patients taking biological therapy for chronic inflammatory joint: A retrospective study. Joint Bone Spine 2015; 83:155-9. [PMID: 26725745 DOI: 10.1016/j.jbspin.2015.11.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate influenza and pneumococcal vaccine coverage in patients taking biological therapy for chronic inflammatory joint disease and to identify factors associated with the decision to administer these two vaccines. METHODS Retrospective cross-sectional questionnaire study of a cohort of 584 patients taking biological therapy for chronic inflammatory joint disease (rheumatoid arthritis or spondyloarthritis). We studied the influenza and pneumococcal vaccine coverage rates, information about these vaccines given to patients by the primary-care physician and rheumatologist, and reasons for not administering the vaccines. RESULTS Overall vaccine coverage rates were 44% for influenza and 62% for pneumococcus. Factors associated with being vaccinated were patient age, previous influenza vaccination, and patient information. Concern about adverse effects and absence of patient information by the primary-care physician and rheumatologist were associated with very low coverage rates. CONCLUSION This study showed insufficient vaccine coverage rates, particularly against influenza, in a population at high risk because of exposure to biological therapy. Patient information by healthcare professionals about influenza and pneumococcal vaccination has a major impact and should be renewed as often as possible.
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Affiliation(s)
- Olivier Brocq
- Rhumatologie, centre hospitalier Princesse Grâce, boulevard Pasteur, 98000 Monaco, Monaco.
| | - Emilie Acquacalda
- Service de rhumatologie, hôpital Archet 1, université de Nice, 06200 Nice, France
| | | | - Christine Albert
- Service de rhumatologie, hôpital Archet 1, université de Nice, 06200 Nice, France
| | - Gilles Bolla
- Service de rhumatologie, centre hospitalier de Cannes, 06400 Cannes, France
| | - Elodie Millasseau
- Service de rhumatologie, centre hospitalier Fréjus-Saint-Raphaël, 83800 Saint-Raphaël, France
| | - Claire Destombe
- Service de rhumatologie, centre hospitalier Fréjus-Saint-Raphaël, 83800 Saint-Raphaël, France
| | - Johanna Azulay
- Service de rhumatologie, centre hospitalier de Cannes, 06400 Cannes, France
| | - Caroline Asquier
- Service de rhumatologie, centre hospitalier de Cannes, 06400 Cannes, France
| | - Amélie Florent
- Service de rhumatologie, hôpital Archet 1, université de Nice, 06200 Nice, France
| | - Sylvie Le Seaux
- Service de rhumatologie, centre hospitalier Fréjus-Saint-Raphaël, 83800 Saint-Raphaël, France
| | - Liana Euller-Ziegler
- Service de rhumatologie, hôpital Archet 1, université de Nice, 06200 Nice, France
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14
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Ai JW, Zhang S, Ruan QL, Yu YQ, Zhang BY, Liu QH, Zhang WH. The Risk of Tuberculosis in Patients with Rheumatoid Arthritis Treated with Tumor Necrosis Factor-α Antagonist: A Metaanalysis of Both Randomized Controlled Trials and Registry/Cohort Studies. J Rheumatol 2015; 42:2229-37. [PMID: 26472414 DOI: 10.3899/jrheum.150057] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Tumor necrosis factor-α (TNF-α) antagonists have significantly improved treatment results in rheumatoid arthritis (RA), but have also increased the risk of tuberculosis (TB). Etanercept (ETN), adalimumab (ADA), infliximab (IFX), golimumab, and certolizumab pegol are the 5 drugs currently available on the market. This article aimed to evaluate the risk of TB infection from these 5 drugs for patients with RA. METHODS We searched PubMed, EMBASE, COCHRANE library, OVID, and EBSCO for randomized controlled trials (RCT) of TNF-α antagonist versus control and registry/longitudinal cohort studies of 1 TNF-α antagonist versus another. The Mantel-Haenszel test was adopted to analyze risk ratio (RR) in this metaanalysis. RESULTS Fifty RCT and 13 non-RCT were included in this study. No significant difference in TB risk was found in the RCT because of the short observational periods. In the non-RCT, TNF-α antagonist was associated with a higher TB risk in patients with RA (RR 4.03, 95% CI 2.36-6.88), and the TB incidence rates of IFX and ADA were 2.78 and 3.88 times, respectively, higher than that of ETN. Further, preventive treatment for latent TB infection (LTBI) was shown to reduce the TB risk by 65% (RR 0.35, 95% CI 0.15-0.82). CONCLUSION This study demonstrated a significant increase in TB risk in patients with RA treated with TNF-α antagonists; among them, ETN is least likely to cause active TB. The study also proposes the necessity of LTBI prophylaxis in patients with RA.
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Affiliation(s)
- Jing-Wen Ai
- From the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.J.W. Ai, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; S. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.L. Ruan, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Y.Q. Yu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; B.Y. Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.H. Liu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; W.H. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University
| | - Shu Zhang
- From the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.J.W. Ai, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; S. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.L. Ruan, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Y.Q. Yu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; B.Y. Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.H. Liu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; W.H. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University
| | - Qiao-Ling Ruan
- From the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.J.W. Ai, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; S. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.L. Ruan, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Y.Q. Yu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; B.Y. Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.H. Liu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; W.H. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University
| | - Yi-Qi Yu
- From the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.J.W. Ai, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; S. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.L. Ruan, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Y.Q. Yu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; B.Y. Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.H. Liu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; W.H. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University
| | - Bing-Yan Zhang
- From the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.J.W. Ai, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; S. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.L. Ruan, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Y.Q. Yu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; B.Y. Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.H. Liu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; W.H. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University
| | - Qi-Hui Liu
- From the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.J.W. Ai, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; S. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.L. Ruan, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Y.Q. Yu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; B.Y. Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.H. Liu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; W.H. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University
| | - Wen-Hong Zhang
- From the Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.J.W. Ai, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; S. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.L. Ruan, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Y.Q. Yu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; B.Y. Zhang, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; Q.H. Liu, MD, Department of Infectious Diseases, Huashan Hospital, Fudan University; W.H. Zhang, MD, PhD, Department of Infectious Diseases, Huashan Hospital, Fudan University.
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15
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Winthrop KL, Novosad SA, Baddley JW, Calabrese L, Chiller T, Polgreen P, Bartalesi F, Lipman M, Mariette X, Lortholary O, Weinblatt ME, Saag M, Smolen J. Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance. Ann Rheum Dis 2015; 74:2107-16. [DOI: 10.1136/annrheumdis-2015-207841] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/28/2015] [Indexed: 12/27/2022]
Abstract
No consensus has previously been formed regarding the types and presentations of infectious pathogens to be considered as ‘opportunistic infections’ (OIs) within the setting of biologic therapy. We systematically reviewed published literature reporting OIs in the setting of biologic therapy for inflammatory diseases. The review sought to describe the OI definitions used within these studies and the types of OIs reported. These findings informed a consensus committee (infectious diseases and rheumatology specialists) in deliberations regarding the development of a candidate list of infections that should be considered as OIs in the setting of biologic therapy. We reviewed 368 clinical trials (randomised controlled/long-term extension), 195 observational studies and numerous case reports/series. Only 11 observational studies defined OIs within their methods; no consistent OI definition was identified across studies. Across all study formats, the most numerous OIs reported were granulomatous infections. The consensus group developed a working definition for OIs as ‘indicator’ infections, defined as specific pathogens or presentations of pathogens that ‘indicate’ the likelihood of an alteration in host immunity in the setting of biologic therapy. Using this framework, consensus was reached upon a list of OIs and case-definitions for their reporting during clinical trials and other studies. Prior studies of OIs in the setting of biologic therapy have used inconsistent definitions. The consensus committee reached agreement upon an OI definition, developed case definitions for reporting of each pathogen, and recommended these be used in future studies to facilitate comparison of infection risk between biologic therapies.
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16
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Inflammatory Bowel Disease: An Overview of Immune Mechanisms and Biological Treatments. Mediators Inflamm 2015; 2015:493012. [PMID: 26339135 PMCID: PMC4539174 DOI: 10.1155/2015/493012] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/27/2015] [Accepted: 03/04/2015] [Indexed: 12/16/2022] Open
Abstract
Inflammatory bowel diseases (IBD) are characterized by chronic inflammation of the intestinal tract associated with an imbalance of the intestinal microbiota. Crohn's disease (CD) and ulcerative colitis (UC) are the most widely known types of IBD and have been the focus of attention due to their increasing incidence. Recent studies have pointed out genes associated with IBD susceptibility that, together with environment factors, may contribute to the outcome of the disease. In ulcerative colitis, there are several therapies available, depending on the stage of the disease. Aminosalicylates, corticosteroids, and cyclosporine are used to treat mild, moderate, and severe disease, respectively. In Crohn's disease, drug choices are dependent on both location and behavior of the disease. Nowadays, advances in treatments for IBD have included biological therapies, based mainly on monoclonal antibodies or fusion proteins, such as anti-TNF drugs. Notwithstanding the high cost involved, these biological therapies show a high index of remission, enabling a significant reduction in cases of surgery and hospitalization. Furthermore, migration inhibitors and new cytokine blockers are also a promising alternative for treating patients with IBD. In this review, an analysis of literature data on biological treatments for IBD is approached, with the main focus on therapies based on emerging recombinant biomolecules.
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17
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Braun J, Kiltz U, Sarholz M, Heldmann F, Regel A, Baraliakos X. Monitoring ankylosing spondylitis: clinically useful markers and prediction of clinical outcomes. Expert Rev Clin Immunol 2015; 11:935-46. [PMID: 26048334 DOI: 10.1586/1744666x.2015.1052795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Patient assessment in axial spondyloarthritis (axSpA) is multidimensional, and monitoring of disease activity, function and radiographic progression is complex. There is no simple 'gold standard' for measuring disease activity in all individual patients, as disease activity in axSpA is the sum of many different aspects and a complexity that cannot be represented by a single variable. Limited spinal mobility is a cardinal sign of ankylosing spondylitis and loss of spinal mobility has been reported to be a prognostic factor and most often evaluated with the Bath Ankylosing Spondylitis Functional Index. Imaging of the spine and assessment of safety aspects plays an important role in the monitoring of patients with axSpA. The timeframe for collecting information regarding disease activity, function and radiographic progression are recommended on an individual basis.
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Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet, Claudiusstr 45, 44649 Herne Germany
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18
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Andersen NN, Jess T. Risk of infections associated with biological treatment in inflammatory bowel disease. World J Gastroenterol 2014; 20:16014-16019. [PMID: 25473153 PMCID: PMC4239487 DOI: 10.3748/wjg.v20.i43.16014] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 07/28/2014] [Accepted: 09/05/2014] [Indexed: 02/07/2023] Open
Abstract
Tumor necrosis factor-α (TNF-α) inhibitors are biological agents introduced in the late 1990s for the treatment of different immune-mediated diseases as inflammatory bowel disease, rheumatoid arthritis and psoriasis. The most commonly used TNF-α antagonists are infliximab, adalimumab, and certolizumab pegol, and though highly effective in lowering inflammation, the efficacy must be weighed against the potential for adverse events. The treatment-induced immunosuppression is suspected to increase the risk of infections, including the risk of reactivation of latent tuberculosis, as the TNF-α cytokine plays an important role in the immune function. In this topic highlight a short overview of the infection risk associated with TNF-α inhibiter therapy is outlined with a focus on the overall risk of serious infections, mycobacterial infection and latent viral infections.
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