The relationship between the use of
tumor necrosis factor antagonists and onset of granulomatous
infection was examined using data collected through the Adverse Event Reporting System of the US Food and Drug Administration for January 1998-September 2002. Granulomatous
infections were reported at rates of approximately 239 per 100,000 patients who received
infliximab and approximately 74 per 100,000 patients who received
etanercept (P<.001).
Tuberculosis was the most frequently reported disease, occurring in approximately 144 and approximately 35 per 100,000
infliximab-treated and
etanercept-treated patients, respectively (P<.001).
Candidiasis,
coccidioidomycosis,
histoplasmosis,
listeriosis,
nocardiosis, and
infections due to nontuberculous mycobacteria were reported with significantly greater frequency among
infliximab-treated patients. Seventy-two percent of these
infection occurred < or =90 days after starting
infliximab treatment, and 28% occurred after starting
etanercept treatment (P<.001). These data indicate a risk of granulomatous
infection that was 3.25-fold greater among patients who received
infliximab than among those who received
etanercept. The clustering of reports shortly after initiation of treatment with
infliximab is consistent with reactivation of
latent infection.