Related Experiment Video
Updated: Feb 28, 2026
Methods to Evaluate Cytotoxicity and Immunosuppression of Combustible Tobacco Product Preparations
Published on: January 10, 2015
Respiratory infections associated with anti-TNFα agents
E Blanchard1, M-E Truchetet2, I Machelart3
1Service des maladies respiratoires, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue Magellan, 33604 Pessac cedex, France.
Abstract:
Anti-TNFα agents have proved effective in the treatment of various inflammatory, rheumatologic, dermatologic, and gastrointestinal diseases. Severe respiratory tract infections of bacterial or fungal origin have emerged as important complications in patients receiving such treatments. The risk of infection due to anti-TNFα therapy is difficult to assess in these patients who are immunocompromised because of the underlying disease itself and of previous or concomitant immunosuppressive drugs. This excessive infection risk seems real, particularly in the first six months following treatment initiation, and higher for patients receiving anti-TNFα monoclonal antibodies than for those receiving soluble TNFα receptor. The involved pathogens are pyogenic bacteria but also Mycobacterium tuberculosis, mostly by reactivation of latent tuberculosis infection, warranting a systematic preventive approach to screening and chemoprophylaxis before initiating the anti-TNFα therapy. In countries with low tuberculosis endemicity, an increased prevalence of nontuberculous mycobacterial infections has been reported. The incidence rate of legionellosis is high in this population. In case of pneumonia, empirical antibiotic therapy should cover Legionella pneumophila. Several cases of histoplasmosis have also been reported and this diagnosis should be suspected in patients who have traveled to endemic areas. Other opportunistic infections have been reported including Pneumocystis pneumonia, aspergillosis, and nocardiosis mostly in patients receiving other immunosuppressive treatments. The risk of infection should be evaluated as an individual risk depending on comorbidities and past or concomitant treatments.
Insights
Anti-tumor necrosis factor alpha (TNFα) therapies can increase the risk of severe respiratory infections, especially within six months of starting treatment. Proactive screening and preventive measures are crucial for immunocompromised patients.
Area of Science:
- Immunology
- Infectious Diseases
- Rheumatology
Background:
- Anti-tumor necrosis factor alpha (TNFα) agents are effective for inflammatory, rheumatologic, dermatologic, and gastrointestinal diseases.
- Patients on anti-TNFα therapy are immunocompromised due to underlying conditions and other immunosuppressants, complicating infection risk assessment.
- Severe respiratory infections, including bacterial and fungal, are significant complications.
Purpose of the Study:
- To evaluate the risk of severe respiratory tract infections in patients treated with anti-TNFα agents.
- To identify specific pathogens and risk factors associated with these infections.
- To emphasize the need for preventive strategies.
Main Methods:
- Review of reported cases and incidence rates of infections in patients receiving anti-TNFα therapy.
- Analysis of pathogen types, including bacteria, Mycobacterium tuberculosis, Legionella, and fungi.
- Assessment of risk factors such as treatment type (monoclonal antibodies vs. soluble receptor) and duration of therapy.
Main Results:
- An increased risk of infection is observed, particularly within the first six months of anti-TNFα therapy.
- Monoclonal anti-TNFα antibodies are associated with a higher risk than soluble TNFα receptor agents.
- Common pathogens include pyogenic bacteria, Mycobacterium tuberculosis (reactivation), Legionella pneumophila, and opportunistic fungi like Histoplasma, Aspergillus, and Pneumocystis.
Conclusions:
- Anti-TNFα therapy necessitates careful evaluation of individual infection risk based on comorbidities and concomitant treatments.
- Systematic screening for tuberculosis and chemoprophylaxis are warranted before initiating anti-TNFα therapy.
- Empirical antibiotic coverage for Legionella should be considered for pneumonia in this patient population.
Related Concept Videos
01:17Drugs Used in Lower Respiratory Disorders: Overview
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
01:24Drugs for Treatment of Crohn's Disease in IBD Using Biologic Agents: Anti-TNF
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:31Common Respiratory Disorders
Upper respiratory disorders impact the airways above the vocal cords, encompassing areas like the nose, sinuses, and throat. Various conditions fall under this category, including the common cold and allergic rhinitis. These disorders can stem from several causes,...
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: