Tumor necrosis factor-alpha inhibitors and mycobacterial infections
- Kevin L Winthrop, MD, MPH
Kevin L Winthrop, MD, MPH
- Associate Professor
- Divisions of Infectious Diseases, Ophthalmology, and Public Health and Preventive Medicine
- Oregon Health and Sciences University
- Section Editors
- C Fordham von Reyn, MD
C Fordham von Reyn, MD
- Section Editor — Tuberculosis; Nontuberculous Mycobacterial Infections
- Professor of Medicine
- Geisel School of Medicine at Dartmouth
- Kieren A Marr, MD
Kieren A Marr, MD
- Section Editor — Compromised Host Infections; Fungal Infections
- Professor of Medicine and Oncology
- Johns Hopkins University School of Medicine
Inhibitors of tumor necrosis factor (TNF)-alpha represent important treatment advances in a number of inflammatory conditions, including rheumatoid arthritis, the seronegative spondyloarthropathies, psoriasis, and inflammatory bowel disease. TNF-alpha inhibitors offer a targeted strategy that contrasts with the nonspecific immunosuppressive agents traditionally used to treat most inflammatory diseases.
However, multiple potential complications and adverse effects of targeted TNF-alpha inhibition have been identified. These include:
●Mycobacterial infections including those due to Mycobacterium tuberculosis (tuberculosis [TB]) and nontuberculous mycobacteria (NTM)
●Other infections (bacterial, viral, and fungal)
●Injection site reactions
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- TNF-ALPHA INHIBITORS
- TNF-ALPHA AND HOST DEFENSES
- Risk of TB
- - Influence of underlying RA
- - Biological basis of differential risks
- Time to onset
- Clinical features of TB in the anti-TNF setting
- Screening and prevention
- - Rescreening
- - Latent TB infection
- Indications for treatment
- - Active TB
- Disease worsening during TB treatment
- NONTUBERCULOUS MYCOBACTERIAL DISEASE
- Screening and diagnosis
- SUMMARY AND RECOMMENDATIONS