A Case of Disseminated Tuberculosis in a Child with Crohn's Disease After Treatment with Azathioprine, Adalimumab and Ustekinumab

Abstract

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Disseminated Mycobacterial Infection With Reactive Polyarthritis (Poncet’s Disease) During Immune-suppressive Treatment Including Ustekinumab for Pediatric Crohn’s Disease

“…[27][28][29][30][31][32] To the best of our knowledge, only 1 other case of TB in a child treated with ustekinumab has been reported to date. Renoux et al 33 described an 11-year-old girl who developed a disseminated M. tuberculosis infection shortly after starting ustekinumab for CD. Similar to our case, the patient had previously undergone multiple immunomodulatory therapies (azathioprine, adalimumab and steroids), had received BCG vaccination in childhood, and had tested negative for Mantoux reaction (with indeterminate IGRAs) before starting immunosuppression.…”

Ustekinumab for steroid-refractory pancolitis in a biologically naive child: A case report and literature review

“…Ustekinumab was started without a new chest X-ray or a repeat interferon gamma release assays test because the child was switched from another biologic. [40] Also, another case described drug-induced lung disease after starting Ustekinumab; the child complained of shortness of breath, chest pain, and cough. [41] Adult clinical trials are expanding the therapeutic options for IBD patients, but the time lag between adult and pediatric drug approval results in significant off-label use due to a lack of knowledge about optimal pediatric dosing regimens.…”

Hepatitis B Virus Reactivation and Mycobacterial Infections Associated With Ustekinumab: A Retrospective Study of an International Pharmacovigilance Database

“…Due to the roles of the IL-12/IL-23 pathway in protecting the host from pathogens, however, ustekinumab may result in unintended downstream consequences such as the development of new infections or reactivation of underlying infections ( Trinchieri, 2003 ; Langrish et al, 2004 ; Tato and Cua, 2008 ; Shen and Chen, 2018 ). Since ustekinumab approval, HBVr, TB, and AMI have been reported occasionally in patients treated with it ( Sánchez-Moya and Daudén, 2012 ; Tsai et al, 2013 ; Errichetti and Piccirillo, 2014 ; Lynch et al, 2017 ; Shim et al, 2018 ; Renoux et al, 2020 ; Akiyama et al, 2021 ; Tominaga et al, 2021 ). To the best of our knowledge, no previous study has investigated the relationships between these infections and ustekinumab exposure by using a pharmacovigilance database.…”

“…Although cases of TB and AMI have been occasionally reported with ustekinumab, ( Sánchez-Moya and Daudén, 2012 ; Tsai et al, 2013 ; Errichetti and Piccirillo, 2014 ; Lynch et al, 2017 ; Shim et al, 2018 ; Renoux et al, 2020 ; Tominaga et al, 2021 ), increased risks to date have not been observed in clinical trials. In fact, ustekinumab is generally safer in terms of infectious complications than TNF inhibitors, the most commonly used biologics in autoimmune diseases ( Kalb et al, 2015 ).…”

“…Of these, hepatitis B virus (HBV) reactivation (HBVr) and tuberculosis (TB) are of particular concern. Since ustekinumab approval, cases of HBVr, TB, or atypical mycobacterial infection (AMI) have been occasionally reported in patients treated with ustekinumab ( Sánchez-Moya and Daudén, 2012 ; Tsai et al, 2013 ; Errichetti and Piccirillo, 2014 ; Lynch et al, 2017 ; Shim et al, 2018 ; Renoux et al, 2020 ; Akiyama et al, 2021 ; Tominaga et al, 2021 ). As pre-marketing trials of ustekinumab usually excluded patients with chronic hepatitis B or active TB, or were conducted in populations with a low prevalence of exposure to HBV and TB, infection and reactivation events were rarely observed in clinical trials.…”