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Pulmonary infectious complications of tumor necrosis factor blockade

Robert S Wallis1, Neil W Schluger

  • 1Pfizer, New London, CT 06320, USA. rswallis@gmail.com

Infectious Disease Clinics of North America
|August 3, 2010
PubMed

Insights

Tumor necrosis factor (TNF) antagonists increase tuberculosis (TB) risk, especially TNF antibodies. Screening and treating latent TB infection significantly reduces this risk in Western countries.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Pharmacology

Background:

  • Tumor necrosis factor (TNF) antagonists are widely used for inflammatory conditions.
  • Understanding infection risks associated with TNF antagonists has evolved since their introduction.
  • TNF antibodies pose a significantly higher risk of tuberculosis (TB) reactivation compared to soluble TNF receptors.

Purpose of the Study:

  • To review the evolving understanding of infection risks, particularly TB, associated with TNF antagonists.
  • To assess the TB risk associated with certolizumab pegol, a specific anti-TNF agent.
  • To discuss current strategies for TB risk mitigation and management in patients receiving anti-TNF therapy.

Main Methods:

  • Review of prospective studies on TNF antagonist-associated TB reactivation.
  • Comparison of TB risks between different TNF antagonist classes (antibodies vs. receptor fusion proteins).
  • Evaluation of the risk profile of certolizumab pegol, considering its unique structure.

Main Results:

  • TNF antibodies confer a several-fold greater risk of TB reactivation than soluble TNF receptors.
  • Certolizumab pegol appears to share this TB reactivation risk, irrespective of its Fc-lacking structure.
  • Two-step tuberculin skin test screening and latent TB treatment effectively reduce TB risk in Western populations.

Conclusions:

  • Proactive screening and treatment for latent TB infection are crucial for mitigating risks associated with anti-TNF therapy.
  • Withdrawal of anti-TNF therapy upon TB diagnosis may lead to paradoxical worsening; alternative management strategies are needed.
  • Further research is required to optimize the prevention and management of infectious complications and explore adjunctive roles of TNF antagonists in chronic infections.

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