Infliximab治疗与结核再度活动有关
WESTPORT, CT (Reuters Health) - Active tuberculosis may develop soon after initiation of treatment with infliximab, according to a report in The New England Journal of Medicine for October 11.
"Before starting patients on infliximab, physicians should make every attempt to make sure that the person is not infected with TB," lead author Dr. Joseph Keane, a TB specialist at Boston University School of Medicine, told Reuters Health.
, 百拇医药 Dr. Keane and colleagues analyzed reports from the US Food and Drug Administration's Adverse Event Reporting System (AERS). Seventy patients were reported to have TB within 1 to 52 weeks after starting treatment with infliximab, an antibody against tumor necrosis factor-alpha that is used in the treatment of Crohn's disease and rheumatoid arthritis.
The investigators note that other serious opportunistic infections have been associated with this drug, but the frequency of TB exceeds that associated with other infections. In addition, "infliximab currently leads all other drugs and biologic products with respect to the number of cases of tuberculosis reported to the AERS," according to the report.
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Based on the reports he analyzed, Dr. Keane described the type of TB that infliximab-treated patients developed as "sinister." More than half had extrapulmonary TB and nearly a quarter developed disseminated infection. Of the 12 patients who died, at least four succumbed as a direct result of the TB.
The investigators believe that most of the patients had reactivation disease, based on the older age of the patients, the low number with recent exposure to TB, and the low incidence of TB in the countries where the patients lived.
, http://www.100md.com
Before prescribing infliximab, "it's extremely important to ask patients if they've had a positive skin test in the past," Dr. Keane emphasized. "If they did, ask if they took isoniazid for 9 months."
Other questions he said physicians should ask are whether the patient has ever been exposed to a person with TB, or ever lived in a country such as India or one of the many African countries where TB is highly prevalent.
Dr. Keane recommended that if a skin test shows the patient is infected, isoniazid treatment should be initiated at the same time as infliximab. When prescribing infliximab, physicians should counsel patients about symptoms that might suggest tuberculosis and the need to seek medical attention if such symptoms appear.
, http://www.100md.com
There may actually be a bright side to the finding that infliximab therapy increases the risk of TB, Dr. Keane pointed out. He explained that scientists working with cells and with mice know that tumor necrosis factor (TNF) is important in the immune response to TB, but up until now, they have seen no evidence of TNF's influence on TB in human beings.
"So we were being laughed out of court every time we talked about it," he grumbled. "'You're looking at mice; who cares about mice?' 'That may be important for Mickey Mouse, but it's not important for my patients,' other physicians would say."
, http://www.100md.com
Observing infliximab's ability to reactivate TB "confirms that TNF is important in TB," Dr. Keane said. "Maybe someday we can use that information to rescue patients who are losing their battle with TB by supporting TNF. Perhaps we could even use this information to design a better vaccine."
"Perhaps we can end this plague that kills more people than any other bacteria," he concluded., http://www.100md.com
"Before starting patients on infliximab, physicians should make every attempt to make sure that the person is not infected with TB," lead author Dr. Joseph Keane, a TB specialist at Boston University School of Medicine, told Reuters Health.
, 百拇医药 Dr. Keane and colleagues analyzed reports from the US Food and Drug Administration's Adverse Event Reporting System (AERS). Seventy patients were reported to have TB within 1 to 52 weeks after starting treatment with infliximab, an antibody against tumor necrosis factor-alpha that is used in the treatment of Crohn's disease and rheumatoid arthritis.
The investigators note that other serious opportunistic infections have been associated with this drug, but the frequency of TB exceeds that associated with other infections. In addition, "infliximab currently leads all other drugs and biologic products with respect to the number of cases of tuberculosis reported to the AERS," according to the report.
, http://www.100md.com
Based on the reports he analyzed, Dr. Keane described the type of TB that infliximab-treated patients developed as "sinister." More than half had extrapulmonary TB and nearly a quarter developed disseminated infection. Of the 12 patients who died, at least four succumbed as a direct result of the TB.
The investigators believe that most of the patients had reactivation disease, based on the older age of the patients, the low number with recent exposure to TB, and the low incidence of TB in the countries where the patients lived.
, http://www.100md.com
Before prescribing infliximab, "it's extremely important to ask patients if they've had a positive skin test in the past," Dr. Keane emphasized. "If they did, ask if they took isoniazid for 9 months."
Other questions he said physicians should ask are whether the patient has ever been exposed to a person with TB, or ever lived in a country such as India or one of the many African countries where TB is highly prevalent.
Dr. Keane recommended that if a skin test shows the patient is infected, isoniazid treatment should be initiated at the same time as infliximab. When prescribing infliximab, physicians should counsel patients about symptoms that might suggest tuberculosis and the need to seek medical attention if such symptoms appear.
, http://www.100md.com
There may actually be a bright side to the finding that infliximab therapy increases the risk of TB, Dr. Keane pointed out. He explained that scientists working with cells and with mice know that tumor necrosis factor (TNF) is important in the immune response to TB, but up until now, they have seen no evidence of TNF's influence on TB in human beings.
"So we were being laughed out of court every time we talked about it," he grumbled. "'You're looking at mice; who cares about mice?' 'That may be important for Mickey Mouse, but it's not important for my patients,' other physicians would say."
, http://www.100md.com
Observing infliximab's ability to reactivate TB "confirms that TNF is important in TB," Dr. Keane said. "Maybe someday we can use that information to rescue patients who are losing their battle with TB by supporting TNF. Perhaps we could even use this information to design a better vaccine."
"Perhaps we can end this plague that kills more people than any other bacteria," he concluded., http://www.100md.com