Incidences of serious infections and tuberculosis among patients receiving anti-tumor necrosis factor-α therapy.
PURPOSE
Anti-tumor necrosis factor-alpha (TNF-α) medications represent a major advancement in the management of chronic inflammatory diseases. However, these agents are associated with increased risks of tuberculosis (TB) and other serious infections. The aim of this study was to evaluate the incidences of such disease among tertiary hospitals in Korea.


MATERIALS AND METHODS
We retrospectively studied patients who received anti-TNF-α therapy; we reviewed serious infections including TB that developed within 6 months after initiation of anti-TNF-α therapy. Data concerning patient demographics, types of anti-TNF-α agents, concomitant immunosuppressive drugs use, and infection details were collected.


RESULTS
A total 175 patients treated with infliximab (n=72) or adalimumab (n=103) with the following conditions were enrolled: Crohn's disease, 34 (19.4%); ulcerative colitis, 20 (11.4%); ankylosing spondylitis, 82 (46.9%); and rheumatoid arthritis, 39 (22.2%). There were 18 cases (6.0%) of serious infections. The most common site of serious infection was the intra-abdomen (n=6), followed by TB (n=3), skin and soft tissue (n=3), bone and joints (n=2), ocular neurons (n=2), lower respiratory tract (n=1), and urinary tract (n=1). Of the 175 patients, only 3 cases showed development of TB. Furthermore, of all those who developed TB, none had taken anti-TB chemoprophylaxis prior to treatment with an anti-TNF agent due to negative screening results.


CONCLUSION
Serious infections with anti-TNF-α therapy were uncommon among tertiary hospitals in Korea; TB was the second most frequent infection. Nevertheless, there were no TB reactivations after anti-TB chemoprophylaxis. Accordingly, physicians should be aware of TB in subjects undergoing anti-TNF-α therapy, especially in countries with a high prevalence of TB.
['Yoo|In Kyung|IK|', 'Choung|Rok Seon|RS|', 'Hyun|Jong Jin|JJ|', 'Kim|Seung Young|SY|', 'Jung|Sung Woo|SW|', 'Koo|Ja Seol|JS|', 'Lee|Sang Woo|SW|', 'Choi|Jai Hyun|JH|', 'Kim|Ho|H|', 'Lee|Hong Sik|HS|', 'Keum|Bora|B|', 'Kim|Eun Sun|ES|', 'Jeen|Yoon Tae|YT|']
D000068879:Adalimumab D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000894:Anti-Inflammatory Agents, Non-Steroidal D000911:Antibodies, Monoclonal D061067:Antibodies, Monoclonal, Humanized D001172:Arthritis, Rheumatoid D003093:Colitis, Ulcerative D003424:Crohn Disease D005260:Female D006801:Humans D007239:Infections D000069285:Infliximab D008297:Male D008875:Middle Aged D058990:Molecular Targeted Therapy D009369:Neoplasms D056910:Republic of Korea D012189:Retrospective Studies D013167:Spondylitis, Ankylosing D062606:Tertiary Care Centers D016896:Treatment Outcome D014376:Tuberculosis D014409:Tumor Necrosis Factor-alpha D055815:Young Adult
infection tuberculosis Tumor necrosis factor-alpha