(Re-)introduction of TNF antagonists and JAK inhibitors in patients with previous tuberculosis: a systematic review

Brehm, Thomas Theo; Reimann, Maja; Köhler, Niklas; Lange, Christoph

doi:10.1016/j.cmi.2024.04.011

Cited by 1 publication

(1 citation statement)

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“…A recent systematic literature review assessed the risk of TB relapse in patients who started or restarted TNF antagonists of JAK inhibitors. Of 368 patients with TB who initiated or reinitiated anti-TNF, only 14 (3.8%) relapsed after a median 8.5 months following the initiation/reinitiation [ 25 ]. Thus, it seems reasonable to restart treatment as soon as the bacillary load has been reduced by anti-TB treatment, either in the case of IBD activity requiring anti-TNF or in the case of symptomatic or severe IRIS.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis and Immune Reconstitution Inflammatory Syndrome in Patients With Inflammatory Bowel Disease and Anti-TNFα Treatment: Insights From a French Multicenter Study and Systematic Literature Review With Emphasis on Paradoxical Anti-TNFα Resumption

Amoura,

Frapard,

Treton

et al. 2024

Open Forum Infectious Diseases

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Background The advent of anti–tumor necrosis factor α (anti-TNFα) has revolutionized the treatment of inflammatory bowel disease (IBD). However, susceptibility to active tuberculosis (TB) is associated with this therapy and requires its discontinuation. The risk of immune reconstitution inflammatory syndrome (IRIS) in this population is poorly understood, as is the safety of resuming anti-TNFα. Methods This French retrospective study (2010–2022) included all TB cases in patients with IBD who were treated with anti-TNFα in 6 participating centers. A systematic literature review was performed on TB-IRIS and anti-TNFα exposure. Results Thirty-six patients were included (median age, 35 years; IQR, 27–48). TB was disseminated in 86% and miliary in 53%. IRIS occurred in 47% after a median 45 days (IQR, 18–80). Most patients with TB-IRIS (93%) had disseminated TB. Miliary TB was associated with IRIS risk in univariate analysis (odds ratio, 7.33; 95% CI, 1.60–42.82; P = .015). Anti-TB treatment was longer in this population (median [IQR], 9 [9–12] vs 6 [6–9] months; P = .049). Anti-TNFα was resumed in 66% after a median 4 months (IQR, 3–10) for IBD activity (76%) or IRIS treatment (24%), with only 1 case of TB relapse. Fifty-two cases of TB-IRIS in patients treated with anti-TNFα were reported in the literature, complicating disseminating TB (85%) after a median 42 days (IQR, 21–90), with 70% requiring anti-inflammatory treatment. Forty cases of TB-IRIS or paradoxical reaction treated with anti-TNFα were also reported. IRIS was neurologic in 64%. Outcome was mostly favorable (93% recovery). Conclusions TB with anti-TNFα treatment is often complicated by IRIS of varying severity. Restarting anti-TNFα is a safe and effective strategy.

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Section: Discussionmentioning

confidence: 99%