Abstract | BACKGROUND: OBJECTIVE: To describe the spectrum of non- tuberculosis OIs associated with anti-TNF therapy and identify their risk factors. METHODS: A 3-year national French registry (RATIO) collected all cases of OI in patients receiving anti-TNF treatment for any indication in France. A case-control study was performed with three controls treated with anti-TNF agents per case, matched for gender and underlying inflammatory disease. RESULTS: 45 cases were collected of non-TB OIs in 43 patients receiving infliximab (n=29), adalimumab (n=10) or etanercept (n=4) for rheumatoid arthritis (n=26), spondyloarthritides (n=3), inflammatory colitis (n=8), psoriasis (n=1) or other conditions (n=5). One-third (33%) of OIs were bacterial (4 listeriosis, 4 nocardiosis, 4 atypical mycobacteriosis, 3 non- typhoid salmonellosis), 40% were viral (8 severe herpes zoster, 3 varicella, 3 extensive herpes simplex, 4 disseminated cytomegalovirus infections), 22% were fungal (5 pneumocystosis, 3 invasive aspergillosis, 2 cryptococcosis) and 4% were parasitic (2 leishmaniasis). Ten patients (23%) required admission to the intensive care unit, and four patients (9%) died. Risk factors for OIs were treatment with infliximab (OR=17.6 (95% CI 4.3 - 72.9); p<0.0001)or adalimumab (OR=10.0 (2.3 to 44.4); p=0.002) versus etanercept, and oral steroid use >10 mg/day or intravenous boluses during the previous year (OR=6.3 (2.0 to 20.0); p=0.002). CONCLUSION: Various and severe OIs, especially those with intracellular micro-organisms, may develop in patients receiving anti-TNF treatment. Monoclonal anti-TNF antibody rather than soluble TNF receptor therapy and steroid use >10 mg/day are independently associated with OI.
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Authors | D Salmon-Ceron, F Tubach, O Lortholary, O Chosidow, S Bretagne, N Nicolas, E Cuillerier, B Fautrel, C Michelet, J Morel, X Puéchal, D Wendling, M Lemann, P Ravaud, X Mariette, RATIO group |
Journal | Annals of the rheumatic diseases
(Ann Rheum Dis)
Vol. 70
Issue 4
Pg. 616-23
(Apr 2011)
ISSN: 1468-2060 [Electronic] England |
PMID | 21177290
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Inflammatory Agents
- Antibodies, Monoclonal
- Antibodies, Monoclonal, Humanized
- Antirheumatic Agents
- Immunoglobulin G
- Immunologic Factors
- Receptors, Tumor Necrosis Factor
- Tumor Necrosis Factor-alpha
- Infliximab
- Adalimumab
- Etanercept
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Topics |
- Adalimumab
- Adult
- Aged
- Anti-Inflammatory Agents
(adverse effects)
- Antibodies, Monoclonal
(adverse effects)
- Antibodies, Monoclonal, Humanized
- Antirheumatic Agents
(adverse effects)
- Epidemiologic Methods
- Etanercept
- Female
- France
(epidemiology)
- Humans
- Immunoglobulin G
(adverse effects)
- Immunologic Factors
(adverse effects)
- Infliximab
- Male
- Middle Aged
- Opportunistic Infections
(chemically induced, epidemiology)
- Receptors, Tumor Necrosis Factor
- Tumor Necrosis Factor-alpha
(antagonists & inhibitors)
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