Post-graduate School of Paediatrics, Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.
Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
Acta Biomed. 2020 Sep 15;91(11-S):e2020009. doi: 10.23750/abm.v91i11-S.10311.
Since the introduction of biologic response modifiers (BRMs) in the management of children affected by the immune-mediated inflammatory disease, these patients substantially improved their quality of life. BRMs are generally well tolerated and effective in most children and adolescents refractory to conventional immunosuppressive therapy. On the other hand, patients receiving BRMs, especially TNF-α inhibitors, display an increased risk of primary infections or reactivations, i.e. due to Mycobacterium tuberculosis. M. tuberculosis can cause severe disease with consequent short- and long-term morbidity in children on anti-TNF-α treatment. The present paper analyses the increased risk of reactivation of latent tuberculosis infection (LTBI) or de novo TB infection in children treated with TNF-α inhibitors, with the purpose to provide recommendations for screening strategies and safety monitoring of paediatric patients. Special attention is also given to the currently available TB screening tools (IGRAs and TST) and their utility in the diagnosis of LTBI before starting the biologic therapy and during the treatment. Finally, the paper analyses the suggested TB-preventing therapies to adopt in these children and the correct timing to overlap anti-TB and anti-TNF-a treatment.
自生物反应调节剂 (BRMs) 引入儿童免疫介导性炎症性疾病的治疗以来，这些患者的生活质量得到了显著改善。BRMs 在大多数对传统免疫抑制治疗无反应的儿童和青少年中通常具有良好的耐受性和疗效。另一方面，接受 BRMs 治疗的患者，特别是 TNF-α 抑制剂，会增加原发性感染或再激活的风险，即由于结核分枝杆菌。结核分枝杆菌可导致严重疾病，并在接受抗 TNF-α 治疗的儿童中产生短期和长期的发病率。本文分析了接受 TNF-α 抑制剂治疗的儿童潜伏性结核感染 (LTBI) 或新发结核感染的再激活风险，旨在为儿科患者的筛查策略和安全性监测提供建议。本文还特别关注目前可用的结核筛查工具（IGRAs 和 TST）及其在开始生物治疗前和治疗期间诊断 LTBI 的效用。最后，本文分析了建议在这些儿童中采用的预防结核治疗方法以及重叠抗结核和抗 TNF-a 治疗的正确时机。
