[Tuberculosis during treatment by TNFalpha-inhibitors].
The clinical forms of tuberculosis that occur during anti-TNFalpha treatment are frequently extrapulmonary or even disseminated and life-threatening. The paradoxical reactions that can occur under appropriate treatment after stopping TNFalpha inhibitors raise the question of an immune restoration phenomenon. Adverse drug reaction reporting and epidemiologic studies, despite their methodological limitations, appear to show an excess risk of tuberculosis. Experimental studies reinforce these data. The French drug agency (Afssaps) has issued guidelines for the prevention and management of tuberculosis occurring under anti-TNFalpha treatment. Analogous guidelines in Spain led to a reduction in the incidence of these cases.
Strady
Christophe
C
Service de médecine interne et des maladies infectieuses, Hôpital Robert Debré, Reims (51). Electronic address: cstrady@chu-reims.fr.
Brochot
Pascal
P
Service de rhumatologie, Hôpital Sébastopol, Rue de Sébastopol, Reims (51).
Ainine
Kamel
K
Service de médecine interne et des maladies infectieuses, Hôpital Robert Debré, Reims (51).
Jegou
Juliette
J
Service de médecine interne et des maladies infectieuses, Hôpital Robert Debré, Reims (51).
Remy
Gérard
G
Service de médecine interne et des maladies infectieuses, Hôpital Robert Debré, Reims (51).
Eschard
Jean-Paul
JP
Service de rhumatologie, Hôpital Sébastopol, Rue de Sébastopol, Reims (51).
Jaussaud
Roland
R
Service de médecine interne et des maladies infectieuses, Hôpital Robert Debré, Reims (51).
D016907:Adverse Drug Reaction Reporting Systems; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects* / Q000627:therapeutic use; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000276:immunology / Q000302:isolation & purification; D017410:Practice Guidelines as Topic; D013902:Radiography, Thoracic; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D025241:Spondylarthritis / Q000188:drug therapy; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D014391:Tuberculosis, Miliary / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology*
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept