Reactivation of latent granulomatous infections by infliximab

Although infliximab and etanercept share tumor necrosis factor (TNF) as a common therapeutic target, accumulating data indicate that infliximab (an anti-TNF monoclonal antibody) poses a greater risk of reactivation of latent granulomatous infections than does etanercept (a soluble TNF receptor). Similarly, infliximab is effective for the treatment of chronic granulomatous inflammatory conditions (e.g., Crohn disease) for which etanercept is ineffective. The ability of infliximab to disrupt established granulomas may be distinct from its ability to neutralize soluble TNF. Further research to elucidate the mechanism of the antigranuloma activity of infliximab is warranted.