title: Infection risk associated with anti-TNF-α agents: a review.
abstract: BACKGROUND
  TNF-α is a pro-inflammatory cytokine known to a have a key role in the pathogenesis of chronic immune-mediated diseases. TNF-α inhibitors can be administered either as monotherapy or in combination with other anti-inflammatory or disease-modifying anti-rheumatic drugs (DMARDs) to treat chronic immune-mediated diseases.
  
  
  METHODS
  Patients receiving TNF-α inhibitors are at high risk of infections. Based on our experience, in this paper, we discuss the risk of infections associated with the administration of TNF-α inhibitors and the strategies for mitigating against the development of these serious adverse events.
  
  
  CONCLUSIONS
  Infliximab more so than etanercept appears to be responsible for the increased risk of infections. Re-activation of latent tuberculosis (LTB) infection and the overall risk of opportunistic infections should be considered before beginning TNF-α inhibitor therapy. A careful medical history, Mantoux test and chest-x-ray should always be performed before prescribing TNF-α inhibitors. Particular attention should be paid to risk factors for Pneumocystis jirovecii infection. Hepatitis B and C virological follow-up should be considered during TNF-α inhibitor treatment. Finally, patients who are at high risk of herpes zoster (HZ) reactivation would benefit from a second vaccination in adulthood when receiving TNF-α inhibitors.
authors: University of Genova, Department of Internal Medicine, Clinical Immunology Unit , Viale Benedetto XV, n. 6, 16132 Genova , Italy +39 0103537924 ; +39 0105556950 ; Giuseppe.Murdaca@unige.it.
authors: Giuseppe
authors: G
authors: Murdaca
authors: Francesca
authors: F
authors: Spanò
authors: Miriam
authors: M
authors: Contatore
authors: Andrea
authors: A
authors: Guastalla
authors: Elena
authors: E
authors: Penza
authors: Ottavia
authors: O
authors: Magnani
authors: Francesco
authors: F
authors: Puppo
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000068800:Etanercept / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007154:Immune System Diseases / Q000188:drug therapy; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects*; D007239:Infections / Q000453:epidemiology / Q000209:etiology*; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068800:Etanercept
keywords: TNF-α inhibitors; hepatitis B virus; hepatitis C virus; infections; tuberculosis