Infection risk associated with anti-TNF-α agents: a review

Abstract

Infliximab more so than etanercept appears to be responsible for the increased risk of infections. Re-activation of latent tuberculosis (LTB) infection and the overall risk of opportunistic infections should be considered before beginning TNF-α inhibitor therapy. A careful medical history, Mantoux test and chest-x-ray should always be performed before prescribing TNF-α inhibitors. Particular attention should be paid to risk factors for Pneumocystis jirovecii infection. Hepatitis B and C virological follow-up should be considered during TNF-α inhibitor treatment. Finally, patients who are at high risk of herpes zoster (HZ) reactivation would benefit from a second vaccination in adulthood when receiving TNF-α inhibitors.

Selenium Deficiency-Induced Inflammation and Increased Expression of Regulating Inflammatory Cytokines in the Chicken Gastrointestinal Tract

“…TNF-α has various effects in inflammation, such as infiltration of neutrophils, activation of neutrophils, impairment of endothelial cells, promotion of secretion of oxygen-derived free radicals and aggravation of the inflammatory cascade [34,35]. TNF-α is expressed during the initiation of an inflammatory response [36].…”

Fulminant Hepatic Failure in a Patient with Crohn’s Disease on Infliximab Possibly Related to Reactivation of Herpes Simplex Virus 2 Infection

“…While HSV hepatitis has not previously been reported in a patient on Infliximab, it is well known that the use of TNF α inhibitors can lead to reactivation of latent infections [21]. In terms of viral infections, hepatitis B (HBV) and hepatitis C (HCV) are the best studied in patients on TNF α inhibitors [22].…”

Biological treatments

“…Di¤er yandan, anti-TNF tedavisiyle inflamasyonun kontrol alt›na al›nmas› sayesinde, immün sistemin toparlad›¤›, Treg hücre fonksiyonlar›n›n düzeldi¤i ve bunun da immün sistemin enfeksiyonlarla mücadelesini olumlu etkileyece¤i de öne sürülmüfltür. [4,25] Anti-TNF ajanlara ba¤l› enfeksiyonlarla ilgili di¤er bir gözlem de, tedaviye baflland›ktan sonraki ilk 6 ay içinde bu riskin en yüksek oldu¤u ve bu riskin zaman içnde azald›¤›d›r. Fakat bu gözlemde zaman içinde enfeksiyona yatk›n hastalar›n ay›klanmas›, bu hastalarda ilac›n kesilmesi ve izlemden ç›kmalar›n›n da katk›s› olabilir.…”