The use of TNF-α antagonists in tuberculosis to control severe paradoxical reaction or immune reconstitution inflammatory syndrome: a case series and literature review

Armange, Lucas; Lacroix, Adèle; Petitgas, Paul; Arvieux, Cédric; Piau-Couapel, Caroline; Poubeau, P.; Revest, Matthieu; Tattevin, Pierre

doi:10.1007/s10096-023-04564-2

Cited by 15 publications

(4 citation statements)

References 20 publications

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“…These immunological considerations have prompted some clinicians to use anti-TNF-α antibody as a rescue treatment in steroid-dependent TB IRIS involving the CNS [ 18 , 19 ]. More recently, Armange et al showed an efficiency of TNF-α antagonists as salvage or corticosteroid-sparing therapeutic in 24 patients with severe IRIS related to TB [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Successful rescue TNF-α blocking for Mycobacterium genavense – Related immune reconstitution inflammatory syndrome: A case report

Bes-Berlandier,

Garzaro,

Rouzaud

et al. 2024

Heliyon

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Section: Discussionmentioning

confidence: 99%

Successful rescue TNF-α blocking for Mycobacterium genavense – Related immune reconstitution inflammatory syndrome: A case report

Bes-Berlandier,

Garzaro,

Rouzaud

et al. 2024

Heliyon

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“…Here, the significance of anti-TNF therapy comes into play as salvage therapy. In a literature review conducted by Armange et al, all 24 patients on TNF-α antagonists showed improvement [ 13 ]. Anti-TNF therapy is considered a safe and effective salvage therapy in severe PR.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent review of the usage of anti-TNF in PR/IRIS, 24 cases were identified. Despite being used as a second-line treatment and as a salvage therapy in severe cases, the rate of improvement was 100% [ 13 ]. Here, we present a case report emphasizing the potential benefit of TNF antagonism in PR.…”

Section: Introductionmentioning

confidence: 99%

Spectacular Improvement of Paradoxical Reaction in Tuberculosis after Tumor Necrosis Factor-Alpha Antagonist Therapy

Samad,

Dallevet,

Tandjaoui-Lambiotte

et al. 2023

Cureus

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We report the case of a 42-year-old immunocompetent Indian patient presenting with miliary tuberculosis complicated by respiratory failure requiring intubation. Conventional quadritherapy was initiated for wild-type Mycobacterium tuberculosis . On day 29 of antibiotic treatment, persistent fever and neurological deterioration prompted the diagnosis of multiple brain and medullary tuberculomas, some surrounded by edema. Laboratory investigations ruled out meningitis and subtherapeutic drug concentrations. To enhance cerebrospinal fluid penetration, ethambutol was replaced with levofloxacin on day 30, and rifampicin doses were increased to 30 mg/kg. Dexamethasone was introduced on day 30 to address the paradoxical response to antituberculosis therapy, but neurological deterioration persisted, leading to hemiparesis and coma, with concurrent development of acute respiratory distress syndrome. As salvage therapy, an anti-tumor necrosis factor agent, infliximab (IFX), was administered on day 40. Rapid clinical improvement was observed, marked by awakening and subsequent weaning from respiratory ventilation just eight days after the first IFX infusion. The patient was discharged from the intensive care unit 10 days post-IFX initiation, with steroids discontinued one month after IFX introduction. Both antituberculosis treatment and IFX infusions (seven in total) were maintained for one year. Clinical and radiological evaluation at one year demonstrated complete clinical and radiological recovery.

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“…It ranges from symptomatic treatment to predominantly anti-inflammatory approaches, often including corticosteroid therapy [ 13 ]. Paradoxically, a handful of studies report the use of anti-TNFα agents in this context [ 14 , 15 ].…”

mentioning

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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The use of TNF-α antagonists in tuberculosis to control severe paradoxical reaction or immune reconstitution inflammatory syndrome: a case series and literature review

Cited by 15 publications

References 20 publications

Successful rescue TNF-α blocking for Mycobacterium genavense – Related immune reconstitution inflammatory syndrome: A case report

Successful rescue TNF-α blocking for Mycobacterium genavense – Related immune reconstitution inflammatory syndrome: A case report

Spectacular Improvement of Paradoxical Reaction in Tuberculosis after Tumor Necrosis Factor-Alpha Antagonist Therapy

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

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