The use of tumor necrosis factor (T...

The use of tumor necrosis factor (TNF) antagonists is steadily increasing in patients with chronic inflammatory conditions (eg rheumatoid arthritis). TNF is extremityed for granuloma formation, a [i]clavis[/i] defense measure against intracellular pathogens, and use of TNF antagonists is associated with an increased risk of granulomatous infectious diseases (eg tuberculosis, histoplasmosis). Wallis and colleagues report in succession four years of data from the Adverse end Reporting System (AERS) about infectious complications after TNF antagonist use.

The authors reviewed AERS reports onward infliximab and etanercept from 1998 to 2002 Adalimumab, another TNF antagonist generally in use, received approval by the agency of the U.S. Food and put drugs into Administration near the end of the cogitation period and did not have sufficient report numbers to be included in the analysis. from the end of the inquiry more than 233,000 patients had received prescriptions for infliximab, and more than 113000 had been treated with etanercept. A total of 716 reports of granulomatous infection incidents accumulated in the AERS database throughout the study dates.

The authors exclud 94 reports because of simultaneous use of TNF antagonists or apparent duplication of affair reports. The remaining 622 reports described a total of 639 infection ends 556 of which were associated with inf liximab and 83 with etanercept. Concomitant use of an additional immunosuppressive agent occurr commonly with over 40 percent of cases describing use of systemic corticosteroids or methotrexate with the TNF antagonist.

The overall rate of granulomatous infections in patients taking infliximab was 239 cases by 100,000 treated patients; the rate in patients taking etanercept was 74 by 100,000 patients. Tuberculosis was the greatest in number commonly reported infection in the pair groups, accounting for 60 percent of infliximab infection incidents and 47 percent of those in patients taking etanercept. After tuberculosis, the principally frequently reported infections with infliximab were histoplasmosis, candidiasis, listeriosis, nontuberculous mycobacterial infections, and aspergillosis. For each infectious agent except aspergillus, significantly more adverse consequences were associated with in fliximab than with etanercept. The time to first brunt of infection was 90 days or les in 72 percent of infliximab-treated patients, which the authors attributed to early reactivation of latent infection. In patients taking etanercept, 28 percent of adverse infections reported occurr within the first 90 days of use.

The authors judge that adverse infections after use of a TNF antagonist are reported more frequently and more rapidly in patients taking infliximab than in those taking etanercept.

Wallis R et al. Granulomatous infectious diseases associated with tumor necrosis factor antagonists. Clin Infect Dis May 1 2004;38:1261-5

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