[MYCOBACTERIOSIS ASSOCIATED WITH ADMINISTRATION OF BIOLOGICS]

In recent years, administration- of biologics for immunologic inflammatory diseases, particularly rheumatoid arthritis, has increased obviously. These substances have dramatic effects, but complications of various infections such as tuberculosis are increasing. Biologics is an antonym for synthetic products (compounds), which are the most common type of pharmaceuticals, made by bioengineering materials derived from living organisms including humans. As concerns preparations which inhibit TNF-α that constitutes the basis of human immunity to tuberculosis, there was a fear that there might be an increase in tuberculosis in Japan, where many people have a history of tuberculosis infection due to past epidemics. However, it was confirmed in post-marketing all- case surveillance in Japan that tuberculosis dan be prevented by screening for latent tuberculosis infection (LTBI) in the target patient population, and administering an anti-tubercu- losis drug to patients with the finding of infection before administering a TNF-α inhibitor. The efficacy of prophylaxis is not 100%, however, so there were some patients who not only had complications of tuberculosis, but in whom symp- toms rapidly exacerbated and resulted in death. Since there is a high possibility that death was due to an immune reconstitu- tion inflammatory syndrome, it is necessary to consider re-administering biologics, or administer them continuously without'interruption. As concerns non-tuberculous mycobac- teriosis (NTM) which is rapidly increasing in Japan, on the other hand; its clinical manifestation is non-uniform and lacks effective therapeutic drugs, so administration of biologics had been considered to be contraindicated, but from a close analysis of clinical cases, there is a growing recognition that biologics can be administered under certain conditions.