Opportunistic Infections in Patients Treated with TNF-alpha Blockers.

D. SALMON, R.M. FLIPO, X. MARIETTE, M. LEMANN, C. MICHELET, D. VITTECOQ, O. LORTHOLARY

Author address: 

Cochin Hospital, Paris, France, Lille Hospital, Lille, France, Saint Antoine Hospital, Paris, France, Bicêtre Hospital, Bicêtre, France, Pontchaillou Hospital, Rennes, France, Paul Brousse Hospital, Ville Juif, France, Necker Hospital, Paris, France.

Abstract: 

Background: TNF-alpha blockers are approved for the treatment of rheumatoid arthritis and Crohn's disease, nevertheless their use has been associated with the incidence of serious infections. Methods: To study the type, severity and natural history of opportunistic infections (OI) occurring with these agents, we did a retrospective survey in French Hospital wards involved in TNF-alpha blocker prescriptions from 01/2000 to 9/2002. Participating physicians were asked to notify all OI in treated patients (pts). Moreover, tuberculosis (TB) cases were documented using a standardized questionaire. Results: 170 physicians participated in the study and notified 55 OI: 25 TB, 9 bacterial infections (legionellosis 1, salmonellosis 1, listeriosis 1, severe pyogenic infections 5, chlamydia 1), 17 viral infections (mainly zoster and herpes but also EBV and HPV infections), 4 fungal infections ( aspergillosis 2, candidiasis 1, pneumocystosis 1). TB cases occurred with infliximab treatment (median duration: 12 weeks) in 96% cases and with etanercept in 4%. Median pts age was 60 (27-85). TB risk factors were found in 43% pts (tuberculous contact 30%, latent tuberculosis 40%). 55% pts had extrapulmonary tuberculosis. Diagnosis was bacteriologically confirmed in 78% pts. Despite treatment, 17% pts died within the first year (one from TB). TNF-alpha blockers were restarted in 32% pts after a median treatment duration of 9 months. There was one TB relapse. Conclusion: This survey confirms the high risk of opportunistic infections, not only tuberculosis, in pts treated with TNF-alpha blockers. Reactivation of latent disease in the majority of the TB cases underlines the need for screening for latent TB in order to give the pts an appropriate prophylaxis before prescribing the drug.
2003

abstract No: 

K-557

Full conference title: 

43rd Interscience Conference on Antimicrobial Agents
    • ICAAC 43rd