Cantini Fabrizio, Nannini Carlotta, Niccoli Laura, Petrone Linda, Ippolito Giuseppe, Goletti Delia
Department of Rheumatology, Hospital of Prato, Prato, Italy.
Translational Research Unit, Department of Epidemiology and Preclinical Research, National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy.
Mediators Inflamm. 2017;2017:8909834. doi: 10.1155/2017/8909834. Epub 2017 Jun 1.
Tuberculosis (TB) still represents an important issue for public health in underdeveloped countries, but the use of antitumor necrosis factor agents (anti-TNF) for the treatment of inflammatory rheumatic disorders has reopened the problem also in countries with low TB incidence, due to the increased risk of TB reactivation in subjects with latent tuberculosis infection (LTBI). Over the last 5 years, several non-anti-TNF-targeted biologics have been licensed for the treatment of rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. We reviewed the epidemiology of TB, the role of different cytokines and of the immune system cells involved in the immune response against TB infection, the methods to detect LTBI, and the risk of TB reactivation in patients exposed to non-anti-TNF-targeted biologics. Given the limited role exerted by the cytokines different from TNF, as expected, data from controlled trials, national registries of biologics, and postmarketing surveillance show that the risk of TB reactivation in patients receiving non-anti-TNF-targeted biologics is negligible, hence raising the question whether the screening procedures for LTBI would be necessary.
结核病（TB）在欠发达国家仍是一个重要的公共卫生问题，但由于潜伏性结核感染（LTBI）患者中结核病复发风险增加，使用抗肿瘤坏死因子药物（抗TNF）治疗炎性风湿性疾病在结核病发病率低的国家也再次引发了这一问题。在过去5年中，几种非抗TNF靶向生物制剂已获许可用于治疗类风湿性关节炎、强直性脊柱炎和银屑病关节炎。我们回顾了结核病的流行病学、不同细胞因子和参与抗结核感染免疫反应的免疫系统细胞的作用、检测LTBI的方法以及接触非抗TNF靶向生物制剂患者的结核病复发风险。鉴于与TNF不同的细胞因子作用有限，不出所料，来自对照试验、生物制剂国家登记处和上市后监测的数据表明，接受非抗TNF靶向生物制剂治疗的患者结核病复发风险可忽略不计，因此引发了是否有必要进行LTBI筛查程序的问题。
