1 Wayne State University, Detroit, MI, USA.
2 Harper University Hospital, Detroit, MI, USA.
Ann Pharmacother. 2018 Jun;52(6):571-579. doi: 10.1177/1060028018754896. Epub 2018 Jan 24.
To review the mechanism and association of infectious risk among the tumor-necrosis factor α (TNF-α) antagonists used in inflammatory bowel disease.
A PubMed literature search was performed using the following search terms: infliximab, adalimumab, certolizumab, golimumab, inflammatory bowel disease, crohn's, ulcerative colitis, adverse effects, adverse events, safety, and infection.
Meta-analyses and cohort studies with outcomes pertaining to quantitative infectious risk were reviewed. Case reports and case series describing association between TNF-α inhibitors and infection were also reviewed.
A total of 7 recent meta-analyses of randomized trials demonstrate inconclusive association of infection with TNF-α antagonists. Registry data suggest that medications carry an independent risk of opportunistic infections. Risk factors for infection include older age, malnutrition, diabetes, and possibly combination therapy. Reported infections vary widely but include intracellular and granulomatous bacteria, viruses, and fungi.
TNF-α antagonists are associated with an increased risk of opportunistic infection, although this risk has not been demonstrated conclusively in randomized controlled trials. Knowledge of concomitant risk factors, mechanism of infectious risk, and available treatment options can improve patient care in the clinical setting.
综述在炎症性肠病中使用的肿瘤坏死因子-α（TNF-α）拮抗剂的感染风险的机制和相关性。
使用以下搜索词在 PubMed 文献搜索中进行了检索：英夫利昔单抗、阿达木单抗、certolizumab、戈利木单抗、炎症性肠病、克罗恩病、溃疡性结肠炎、不良反应、不良事件、安全性和感染。
综述了与定量感染风险相关的荟萃分析和队列研究。还回顾了描述 TNF-α 抑制剂与感染之间关联的病例报告和病例系列。
7 项最近的 TNF-α 拮抗剂随机试验的荟萃分析结果表明，感染与 TNF-α 拮抗剂之间的关联尚无定论。登记数据表明，药物具有机会性感染的独立风险。感染的危险因素包括年龄较大、营养不良、糖尿病，以及可能的联合治疗。报告的感染差异很大，但包括细胞内和肉芽肿细菌、病毒和真菌。
TNF-α 拮抗剂与机会性感染的风险增加相关，尽管在随机对照试验中尚未明确证明这一风险。了解伴随的危险因素、感染风险的机制和可用的治疗选择可以改善临床环境中的患者护理。
