The Centre for Inflammatory Bowel Diseases, Fremantle Hospital, University of Western Australia, Fremantle, Western Australia, Australia.
J Gastroenterol Hepatol. 2010 Nov;25(11):1732-8. doi: 10.1111/j.1440-1746.2010.06407.x.
Anti-tumor-necrosis-factor-alpha (anti-TNF-α) medications are effective in inflammatory bowel disease (IBD), but have an increased risk of tuberculosis (TB) and serious infections. The aim of this study was to examine the Australian/New Zealand experience of serious infections and TB in IBD patients receiving anti-TNF-α therapy from 1999-2009.
Serious infections, defined as 'requiring hospital admission' and TB cases in patients receiving, or within 3 months following, anti-TNF-α therapy were analyzed across Australia and New Zealand. Patient demographics, IBD medications, duration of anti-TNF-α therapy, and infection details were collected.
A total of 5562 IBD patients were managed across the centers. Of these, 489 (16.8%) Crohn's disease and 137 (5.2%) ulcerative colitis patients received anti-TNF-α therapy. There were three cases of latent TB that received prophylaxis prior to anti-TNF-α therapy. No cases of active TB were reported. Fourteen (2.2%) serious infections occurred. Seven occurred in patients receiving anti-TNF-α therapy for less than 6 months, including two cases of primary Varicella zoster (VZV), two cases of Pneumocystis jiroveci pneumonia, two cases of Staphylococcus aureus bacteremia, and one severe flu-like illness. Six patients were taking additional immunosuppressive medications. The other seven infections occurred after 6 months (mean 32.6 ± 24.3 months) and included one case of primary VZV, one flu-like illness, and five bacterial infections. All infections resolved with treatment.
TB is a very rare complication of anti-TNF-α therapy in Australia and New Zealand. Serious infections are uncommon but early opportunistic infections with Pneumocystis jiroveci pneumonia suggest a need for vigilance in patients on multiple immunosuppressive medications. VZV vaccination prior to immunosuppressive therapy should be considered in VZV-naïve patients.
抗肿瘤坏死因子-α（anti-TNF-α）药物在炎症性肠病（IBD）中有效，但存在结核（TB）和严重感染的风险增加。本研究的目的是检查澳大利亚/新西兰在 1999 年至 2009 年期间接受抗 TNF-α 治疗的 IBD 患者中严重感染和 TB 的经验。
在澳大利亚和新西兰，分析了接受或在接受抗 TNF-α 治疗后 3 个月内接受治疗的患者中严重感染（定义为“需要住院治疗”）和 TB 病例。收集了患者人口统计学、IBD 药物、抗 TNF-α 治疗持续时间和感染细节。
在各中心共管理了 5562 例 IBD 患者。其中，489 例（16.8%）克罗恩病和 137 例（5.2%）溃疡性结肠炎患者接受了抗 TNF-α 治疗。有 3 例潜伏性 TB 在接受抗 TNF-α 治疗前接受了预防。没有报告活动性 TB 病例。发生了 14 例（2.2%）严重感染。有 7 例发生在接受抗 TNF-α 治疗不到 6 个月的患者中，包括 2 例原发性水痘带状疱疹病毒（VZV）、2 例卡氏肺孢子虫肺炎、2 例金黄色葡萄球菌菌血症和 1 例严重流感样疾病。6 例患者正在服用额外的免疫抑制药物。另外 7 例感染发生在 6 个月后（平均 32.6 ± 24.3 个月），包括 1 例原发性 VZV、1 例流感样疾病和 5 例细菌感染。所有感染均经治疗缓解。
在澳大利亚和新西兰，TB 是抗 TNF-α 治疗的一种非常罕见的并发症。严重感染并不常见，但卡氏肺孢子虫肺炎的早期机会性感染表明，在接受多种免疫抑制药物治疗的患者中需要保持警惕。对于 VZV 未感染的患者，应考虑在接受免疫抑制治疗前接种 VZV 疫苗。
