Review article: minimizing tuberculosis during anti-tumour necrosis factor-alpha treatment of inflammatory bowel disease.

Abstract

BACKGROUND:

Tumour necrosis factor (TNF)-alpha inhibitors are a major advance in the management of inflammatory bowel disease but increase the risk for tuberculosis (TB).

AIM:

To examine the reasons for the increase in the risk for TB and the strategies to reduce it.

METHODS:

PubMed searches were performed using search terms that included TB and each of the current anti-TNF-alpha biological agents and also TB and Crohn's disease.

RESULTS:

Increased susceptibility to TB, often with extrapulmonary or disseminated disease, occurs following treatment with all anti-TNF-alpha biological agents and amounts to a four- to 20-fold increased risk with infliximab. TB usually occurs shortly after anti-TNF-alpha initiation suggesting reactivation of latent infection. Animal studies show that TNF-alpha inhibition impairs inflammatory cell trafficking and granuloma formation. Currently recommended screening for latent TB typically, risk assessment, tuberculin skin testing and chest radiograph used prior to anti-TNF-alpha treatment can reduce TB rates by up to 90% but newer screening interferon gamma assays may enhance screening efficacy. Patients positive on screening who are treated with isoniazid and subsequently receive anti-TNF-alpha treatment still have approximately 19% risk for TB.

CONCLUSIONS:

Tuberculosis following treatment with TNF-alpha inhibitors usually results from reactivation of latent disease. Screening reduces the risk substantially but does not completely eliminate it.

• Authors: V S Theis, J M Rhodes
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 27 Issue 1 Pg. 19-30 (Jan 01 2008) ISSN: 1365-2036 [Electronic] England
• PMID: 17944997 (Publication Type: Journal Article, Review)

Chemical References

• Tumor Necrosis Factor-alpha

Topics

• Animals
• Humans
• Inflammatory Bowel Diseases (drug therapy)
• Radiography, Thoracic
• Risk Assessment
• Tuberculin Test
• Tuberculosis (chemically induced, diagnosis, prevention & control)
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)