Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington.
Department of Dermatopathology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
Am J Trop Med Hyg. 2020 May;102(5):1131-1136. doi: 10.4269/ajtmh.19-0616.
Tumor necrosis factor (TNF)-α inhibitors increase susceptibility to tuberculosis, but the effect of biologics on susceptibility to leprosy has not been described. Moreover, biologics may play a role in treating erythema nodosum leprosum (ENL). The objectives of this systematic review were to determine whether the development of clinical leprosy is increased in patients being treated with biologics and to assess the use of biologics in treating leprosy reactions. A systematic literature review was completed of patients with leprosy who received treatment with biologics either before or after a diagnosis of leprosy was confirmed. All studies and case reports were included for qualitative evaluation. The search yielded 10 cases (including one duplicate publication) of leprosy diagnosed after initiation of TNF-α inhibitors and four case reports of refractory ENL successfully treated with infliximab or etanercept. An unpublished case of persistent ENL responsive to infliximab is also presented. These data demonstrate that the use of TNF-α inhibitors may be a risk factor for developing leprosy or reactivating subclinical infections. Leprosy can present with skin lesions and arthritis, so leprosy should be considered in patients presenting with these signs before starting treatment with these agents. Leprosy should be considered in patients who develop worsening eruptions and neurologic symptoms during treatment with TNF-α inhibitors. Finally, TNF-α inhibitors appear effective in some cases of refractory ENL.
肿瘤坏死因子（TNF）-α 抑制剂会增加结核病的易感性，但生物制剂对麻风病易感性的影响尚未描述。此外，生物制剂可能在治疗结节性红斑麻风（ENL）中发挥作用。本系统评价的目的是确定接受生物制剂治疗的患者中是否会增加临床麻风病的发生，并评估生物制剂在治疗麻风病反应中的应用。对接受生物制剂治疗的麻风病患者进行了系统的文献复习，无论在确诊前还是确诊后使用。对所有研究和病例报告均进行定性评估。检索结果显示，在开始使用 TNF-α 抑制剂后诊断出的麻风病患者有 10 例（包括 1 例重复发表的病例），以及使用英夫利昔单抗或依那西普成功治疗难治性 ENL 的 4 例病例报告。还介绍了一例未发表的持续 ENL 对英夫利昔单抗有反应的病例。这些数据表明，TNF-α 抑制剂的使用可能是导致麻风病发生或重新激活亚临床感染的一个危险因素。麻风病可表现为皮肤损伤和关节炎，因此在开始使用这些药物之前，对于出现这些体征的患者应考虑麻风病。在接受 TNF-α 抑制剂治疗期间出现皮疹加重和神经症状的患者应考虑麻风病。最后，TNF-α 抑制剂似乎对某些难治性 ENL 有效。
