title: Incidences of serious infections and tuberculosis among patients receiving anti-tumor necrosis factor-α therapy.
abstract: OBJECTIVE
  Anti-tumor necrosis factor-alpha (TNF-α) medications represent a major advancement in the management of chronic inflammatory diseases. However, these agents are associated with increased risks of tuberculosis (TB) and other serious infections. The aim of this study was to evaluate the incidences of such disease among tertiary hospitals in Korea.
  
  
  METHODS
  We retrospectively studied patients who received anti-TNF-α therapy; we reviewed serious infections including TB that developed within 6 months after initiation of anti-TNF-α therapy. Data concerning patient demographics, types of anti-TNF-α agents, concomitant immunosuppressive drugs use, and infection details were collected.
  
  
  RESULTS
  A total 175 patients treated with infliximab (n=72) or adalimumab (n=103) with the following conditions were enrolled: Crohn's disease, 34 (19.4%); ulcerative colitis, 20 (11.4%); ankylosing spondylitis, 82 (46.9%); and rheumatoid arthritis, 39 (22.2%). There were 18 cases (6.0%) of serious infections. The most common site of serious infection was the intra-abdomen (n=6), followed by TB (n=3), skin and soft tissue (n=3), bone and joints (n=2), ocular neurons (n=2), lower respiratory tract (n=1), and urinary tract (n=1). Of the 175 patients, only 3 cases showed development of TB. Furthermore, of all those who developed TB, none had taken anti-TB chemoprophylaxis prior to treatment with an anti-TNF agent due to negative screening results.
  
  
  CONCLUSIONS
  Serious infections with anti-TNF-α therapy were uncommon among tertiary hospitals in Korea; TB was the second most frequent infection. Nevertheless, there were no TB reactivations after anti-TB chemoprophylaxis. Accordingly, physicians should be aware of TB in subjects undergoing anti-TNF-α therapy, especially in countries with a high prevalence of TB.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 425-707, Korea. crsdr@korea.ac.kr.
authors.forename: In Kyung
authors.initials: IK
authors.lastname: Yoo
authors.forename: Rok Seon
authors.initials: RS
authors.lastname: Choung
authors.forename: Jong Jin
authors.initials: JJ
authors.lastname: Hyun
authors.forename: Seung Young
authors.initials: SY
authors.lastname: Kim
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Jung
authors.forename: Ja Seol
authors.initials: JS
authors.lastname: Koo
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lee
authors.forename: Jai Hyun
authors.initials: JH
authors.lastname: Choi
authors.forename: Ho
authors.initials: H
authors.lastname: Kim
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Kim
authors.forename: Yoon Tae
authors.initials: YT
authors.lastname: Jeen
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D003093:Colitis, Ulcerative / Q000188:drug therapy; D003424:Crohn Disease / Q000188:drug therapy; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy / Q000009:adverse effects; D009369:Neoplasms / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000188:drug therapy; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014376:Tuberculosis / Q000453:epidemiology*; D014409:Tumor Necrosis Factor-alpha; D055815:Young Adult
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Tumor necrosis factor-alpha; infection; tuberculosis