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

  • Theis V
  • Rhodes J
  • V.S. T
 et al. 
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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. © 2008 The Authors.

Author-supplied keywords

  • Animals
  • Crohn disease
  • Humans
  • Inflammatory Bowel Diseases
  • Medline
  • Radiography
  • Risk Assessment
  • Thoracic
  • Tuberculin Test
  • Tuberculosis
  • Tumor Necrosis Factor-alpha
  • adalimumab
  • antagonists & inhibitors
  • cell migration
  • certolizumab
  • chemically induced
  • diagnosis
  • disease predisposition
  • drug determination
  • drug inhibition
  • drug therapy
  • enteritis
  • etanercept
  • gamma interferon
  • granuloma
  • infection
  • inflammatory cell
  • infliximab
  • isoniazid
  • methotrexate
  • nonhuman
  • population
  • prevention & control
  • priority journal
  • review
  • rheumatoid arthritis
  • rifampicin
  • risk
  • risk assessment
  • risk reduction
  • screening
  • skin test
  • thorax radiography
  • tuberculin
  • tuberculosis
  • tumor necrosis factor antibody
  • unclassified drug

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Authors

  • V S Theis

  • J M Rhodes

  • Theis V.S.

  • Rhodes J.M.

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