Peña-Sagredo J L, Hernández M V, Fernandez-Llanio N, Giménez-Ubeda E, Muñoz-Fernandez S, Ortiz A, Gonzalez-Gay M A, Fariñas M C
Divisions of Rheumatology and Infectious Diseases, Hospital Universitario Marques de Valdecilla, University of Cantabria, Spain.
Clin Exp Rheumatol. 2008 Sep-Oct;26(5):854-9.
The prognosis of patients with rheumatic diseases has improved considerably following the use of biological therapies. However, an increase in the frequency of bacterial infections has been observed in patients receiving these therapies. In the present study we aimed to assess the frequency of Listeria monocytogenes infection in a large series of patients with rheumatic diseases on treatment with tumor necrosis factor (TNF)-alpha blockers because of active disease refractory to conventional therapy, included in the Spanish Registry of Adverse Events of Biological Therapies in Rheumatic Diseases (BIOBADASER) of the Spanish Society for Rheumatology.
Assessment of the incidence of infection due to Listeria monocytogenes in the Spanish Registry Study (BIOBADASER) per 1000 patient-years and 95% confidence intervals (95% CIs) was performed. Rate from this registry was compared with that from the general population in Europe and with the rate found in patients with rheumatoid arthritis (RA) from the Spanish Rheumatoid Arthritis Registry Cohort Study (EMECAR) that assessed morbidity and clinical expression of RA and included patients treated in most cases with conventional therapies.
Six patients on treatment with TNF-alpha antagonists were diagnosed as having Listeria monocytogenes infection. The incidence of this infection per 1000 patient-year (95% CI) was 0.256 (95% CI: 0.115-0.570). This was greater than the incidence observed in the general population from Europe and in the EMECAR study.
Despite the benefits associated to the use of TNF-alpha antagonists, a high level of surveillance is required to reduce the potential risk of infections related to the use of these drugs.
生物疗法应用后，风湿性疾病患者的预后有了显著改善。然而，接受这些疗法的患者中细菌感染的频率有所增加。在本研究中，我们旨在评估一大系列因传统治疗难治的活动性疾病而接受肿瘤坏死因子（TNF）-α阻滞剂治疗的风湿性疾病患者中，单核细胞增生李斯特菌感染的频率，这些患者纳入了西班牙风湿病学会的西班牙生物疗法不良事件登记处（BIOBADASER）。
在西班牙登记研究（BIOBADASER）中，对每1000患者年的单核细胞增生李斯特菌感染发生率及95%置信区间（95%CI）进行评估。将该登记处的发生率与欧洲普通人群的发生率以及西班牙类风湿关节炎登记队列研究（EMECAR）中类风湿关节炎（RA）患者的发生率进行比较，EMECAR研究评估了RA的发病率和临床表现，且大多数患者接受传统疗法治疗。
6例接受TNF-α拮抗剂治疗的患者被诊断为单核细胞增生李斯特菌感染。每1000患者年这种感染的发生率（95%CI）为0.256（95%CI：0.115 - 0.570）。这高于在欧洲普通人群和EMECAR研究中观察到的发生率。
尽管使用TNF-α拮抗剂有诸多益处，但仍需要高度监测以降低使用这些药物相关的感染潜在风险。
