Institut für Tropenmedizin, Eberhard Karls Universität, Wilhelmstrasse, Tübingen, Germany.
Clin Microbiol Infect. 2012 Jul;18(7):670-6. doi: 10.1111/j.1469-0691.2011.03674.x. Epub 2011 Oct 10.
Leishmaniasis is endemic in Europe and the prevalence of latent infection in the Mediterranean region is high. Reports describing opportunistic leishmaniasis in European patients treated with tumor necrosis factor (TNF) alpha antagonist drugs are rapidly accumulating. For other granulomatous infections, risk of opportunistic disease varies by mode of TNF-alpha antagonism. This study explores whether this may also be the case for leishmaniasis. We ascertained the relative frequency of exposure to different TNF antagonist drugs among published cases of opportunistic leishmaniasis in Europe and compared this with the prescription of these drugs in Europe. We found that risk of opportunistic leishmaniasis is higher in patients receiving anti-TNF monoclonal antibodies (infliximab or adalimumab) compared with patients treated with the TNF-receptor construct etanercept. Clinicians may want to consider these observations, which suggest that etanercept should be favoured over anti-TNF monoclonal antibodies in individuals living in or visiting areas endemic for leishmaniasis until evidence from prospective research is available. A European adverse event reporting system is required to identify rare opportunistic infections associated with immunosuppressive and immunomodulatory biotherapies.
利什曼病在欧洲流行，地中海地区潜伏感染的患病率很高。描述在接受肿瘤坏死因子 (TNF)α 拮抗剂药物治疗的欧洲患者中出现机会性利什曼病的报告正在迅速增加。对于其他肉芽肿性感染，机会性疾病的风险因 TNF-α 拮抗方式而异。本研究探讨了这是否也适用于利什曼病。我们确定了在欧洲发表的机会性利什曼病病例中，不同 TNF 拮抗剂药物暴露的相对频率，并将其与这些药物在欧洲的处方情况进行了比较。我们发现，与接受 TNF 受体构建体依那西普治疗的患者相比，接受抗 TNF 单克隆抗体（英夫利昔单抗或阿达木单抗）治疗的患者发生机会性利什曼病的风险更高。临床医生可能需要考虑这些观察结果，这表明在有或有前往利什曼病流行地区的个体中，应优先选择依那西普而非抗 TNF 单克隆抗体，直到有前瞻性研究的证据。需要一个欧洲不良事件报告系统来识别与免疫抑制和免疫调节生物疗法相关的罕见机会性感染。
