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Infections associated with tumor necrosis factor-alpha antagonists
Nancy F Crum1, Edith R Lederman, Mark R Wallace
1From Infectious Diseases Division (NFC, MRW), Naval Medical Center San Diego, San Diego, California and United States Naval Medical Research Unit 2 (ERL), Jakarta, Indonesia.
Medicine
|September 9, 2005
Summary
Tumor necrosis factor (TNF)-alpha antagonists treat autoimmune diseases but increase infection risk. Infliximab poses the greatest risk, necessitating careful patient monitoring and new drug development.
Area of Science:
- Immunology
- Rheumatology
- Infectious Diseases
Background:
- Tumor necrosis factor (TNF)-alpha antagonists are crucial for severe autoimmune and rheumatologic conditions.
- These therapies, however, are linked to increased risks of infections like tuberculosis and bacterial infections.
Observation:
- Infliximab, a TNF-alpha antagonist, shows the highest infection risk, potentially due to its long half-life and monocyte apoptosis induction.
- Four patient cases illustrate severe infections developing during TNF-alpha antagonist therapy.
Findings:
- The use of TNF-alpha antagonists is associated with a significant increase in opportunistic infections.
- Infliximab's pharmacokinetic and pharmacodynamic properties may contribute to its heightened infection risk.
Implications:
- Prospective trials are essential to precisely quantify infection risks with all TNF-alpha antagonists, especially newer agents.
- Development of more targeted TNF-alpha blockers is needed to balance inflammation reduction and immune function.
- Mandatory thorough evaluation for febrile illnesses in patients receiving TNF-alpha blockers is critical for early diagnosis and management.