Because tumor necrosis factor-alpha (TNF-alpha) is an important component of the immune system's response to a variety of infections, TNF inhibitors can cause serious infections. These include bacterial infections (particularly pneumonia), tuberculosis, and opportunistic infections. Because of the increased risk of tuberculosis, a chest radiograph and purified protein derivative (PPD) test should be performed before the initiation of TNF inhibitor therapy. Till now there is no clear correlation between these medications and infections. Data from individual randomized clinical trials failed to demonstrate a consistent increase in treatment-related infections.
Recently (in January of 2009) C. Salliot and colleagues published in Annals of Rheumatic Disease Journal a meta-analyses of randomised placebo-controlled trials addressing the infection risks during rituximab, abatacept and anakinra treatments for rheumatoid arthritis. In summary, these meta-analyses did not reveal a significant increase in the risk of serious infections during rituximab or abatacept treatments in patients with rheumatoid arthritis; however, high doses of anakinra may increase this risk, especially when patients have comorbidity factors. Large studies must be performed to confirm this safety profile in daily practice.
To go to the ARD journal please click here
1 comment:
It is very important to consider the microbiological impact of the new biologic agents in patients with Rheumatoid arthritis. There is a recently published "online first" article (Furst DE. The Risk of Infections with Biologic Therapies for Rheumatoid Arthritis. Semin Arthritis Rheum. 2008 Dec 29).
As per this review, studies indicate that anakinra and the TNF inhibitors are associated with an increased risk of infections versus conventional DMARDs. The risk of tuberculosis also appears higher with TNF inhibitors (in particular, infliximab). It seems that TNF inhibitors do not appear to significantly increase the risk of reactivating chronic viral infections. Abatacept and rituximab may have a similar risk of infection to the TNF inhibitors, although there have been no reports from clinical trials of increased tuberculosis or opportunistic infections with these agents (abatacept or rituximab).
An important emphasis should be made in the setting of perioperative medicine, in which the experience regarding discontinuing these agents is limited. There is a good article about peri-operative management of DMARD's as well as biologic agents:
Pieringer H, Stuby U, Biesenbach G.
Patients with rheumatoid arthritis undergoing surgery: how should we deal with antirheumatic treatment? Semin Arthritis Rheum. 2007 Apr;36(5):278-86.
Post a Comment