Department of Rheumatologic & Immunologic Disease, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A50, Cleveland, OH 44195, USA.
Division of Infectious Diseases, Schools of Medicine and Public Health, Oregon Health and Science University, OHSU, 3181 Sam Jackson Road, Mail Code: Gaines Hall, Portland, OR 97239, USA.
Infect Dis Clin North Am. 2020 Jun;34(2):413-423. doi: 10.1016/j.idc.2020.02.011.
Biologic therapies have revolutionized the treatment of immune-mediated inflammatory diseases but are associated with an increased risk of serious and opportunistic infections, including tuberculosis and nontuberculous mycobacterial disease. Despite this increased risk, the overall risk-benefit ratio remains favorable with appropriate screening and risk assessment. Further population-based studies are needed to establish the risk of tuberculosis and nontuberculous mycobacterial disease with the new biologics. This article highlights the incidence and drug-specific risk of tuberculous and nontuberculous mycobacterial infection in the setting of biologics, screening and prevention, and treatment of latent tuberculosis in this setting.
生物制剂治疗已经彻底改变了免疫介导的炎症性疾病的治疗方法,但与严重和机会性感染(包括结核病和非结核分枝杆菌病)的风险增加相关。尽管存在这种风险增加,但通过适当的筛查和风险评估,总体风险效益比仍然有利。需要进一步的基于人群的研究来确定新型生物制剂的结核病和非结核分枝杆菌病的风险。本文重点介绍了生物制剂治疗中结核和非结核分枝杆菌感染的发生率和药物特异性风险、筛查和预防以及该环境中潜伏性结核病的治疗。