Allergy, Immunology and Rheumatology Division, Internal Medicine Department, Faculty of Medicine, Ramathibodi Hospital, Rama VI Rd., Rachathevi, BKK 10240, Thailand.
Int J Rheum Dis. 2009 Jul;12(2):118-24. doi: 10.1111/j.1756-185X.2009.01393.x.
Anti-tumour necrosis factor-alpha (anti-TNF) agents represented treatment advances in a number of rheumatologic diseases. However, adverse effects of anti-TNF agents have been identified through both clinical trials and post-marketing surveillance, especially an increased risk of serious infections. This study firstly described the infectious profiles of anti-TNF agents in a Thai population.
We retrospectively reviewed all infectious incidences from 100 consecutive medical records of patients who were treated with either etanercept or infliximab for any rheumatologic and non-rheumatologic conditions.
Indications for anti TNF-alpha agents were mainly rheumatoid arthritis (46%) and spondyloarthropathy (SpA) (41%). Seventy-seven patients were treated with etanercept and 23 with infliximab. For those whose initial treatment was etanercept, there were two events of suspected active pulmonary tuberculosis (TB) and suspected hepatitis-B virus (HBV) reactivation. Two out of 23 patients (8.7%) who were firstly treated with infliximab had herpes zoster skin infection. Incidence of overall infection before anti-TNF treatment were significantly higher in patient who started with etanercept (0.065 vs. 0.019 cases per person-years in etanercept and infliximab respectively, P < 0.0001). Incidence of overall infection post-anti-TNF treatment were 0.122 and 0.201 cases per person-years in patients who started with etanercept and infliximab with no significant difference (P > 0.05). The overall infection rates were significantly increased after infliximab treatment (P < 0.0001).
Even thought there were two new events of TB and HBV reactivation after etanercept treatment, incidence of overall infection seemed to be increased after infliximab treatment. The infectious screening and monitoring with high index of suspicion as well as the pre-emptive treatment are still important whenever either etanercept or infliximab is started.
抗肿瘤坏死因子-α（anti-TNF）药物在许多风湿性疾病的治疗中代表了治疗进展。然而，通过临床试验和上市后监测已经确定了抗 TNF 药物的不良反应，特别是严重感染的风险增加。本研究首先描述了 TNF 拮抗剂在泰国人群中的感染概况。
我们回顾性分析了 100 例连续接受依那西普或英夫利昔单抗治疗的患者的病历，这些患者的治疗指征为任何风湿性和非风湿性疾病。
抗 TNF-α药物的适应证主要为类风湿关节炎（46%）和脊柱关节炎（SpA）（41%）。77 例患者接受依那西普治疗，23 例患者接受英夫利昔单抗治疗。在最初接受依那西普治疗的患者中，有 2 例疑似活动性肺结核（TB）和疑似乙型肝炎病毒（HBV）再激活。23 例初次接受英夫利昔单抗治疗的患者中有 2 例发生带状疱疹皮肤感染。在开始使用依那西普治疗的患者中，抗 TNF 治疗前的总感染发生率明显更高（依那西普组为 0.065 例/人年，英夫利昔单抗组为 0.019 例/人年，P < 0.0001）。开始使用依那西普和英夫利昔单抗治疗后，总感染发生率分别为 0.122 和 0.201 例/人年，差异无统计学意义（P > 0.05）。英夫利昔单抗治疗后，总感染率显著增加（P < 0.0001）。
尽管依那西普治疗后有 2 例新发生 TB 和 HBV 再激活事件，但英夫利昔单抗治疗后感染发生率似乎增加。无论使用依那西普还是英夫利昔单抗，都应进行高度怀疑的感染筛查和监测，并进行预防性治疗。
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