Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-alpha therapy.

摘要: Objective. With rising numbers of anti-tumour necrosis factor a (TNF-a) treatments for rheumatoid arthritis (RA), Crohn’s disease and other conditions, physicians unaware potential pitfalls are increasingly likely to encounter associated severe infections. Our purpose was assess the incidence nature infections in our RA patients under anti-TNF-a therapy. Methods. We reviewed patient charts records Infectious Disease Unit serious with 2 yr preceding therapy during Results. Serious affected 18.3% treated infliximab or etanercept. The 0.181 per treatment year vs 0.008 In several cases, only few signs symptoms indicated severity developing infections, including sepsis. Conclusions. A high level suspicion infection is necessary suggest additional strategies prevention, rapid identification pre-emptive such efficacy (TNFa) agents etanercept (RA) has been demonstrated large-scale trials w1‐4x. Their results indicate superior effect these compared conventional disease-modifying anti-rheumatic drugs (DMARDs). Among undesired effects agents, have primary concern. Under study 53% group 3m gukg together methotrexate had an 40% placebo w1x. For any given infection, difference between groups statistically significant. However, defined as life-threatening requiring hospitalization, not different over dose ranges studied (6% 1% every 8 weeks 6% 10 mg 4 weeks). etanercept, occurred 51% active 63% w3x. On basis data, it assumed that were markedly increased when data on w5‐7x. Recently, reactivation tuberculosis, again raising concerns may pose significant threat w8x. addition existing warnings contained package insert, case latter FDA (Food Drug Administration, USA) requested ‘black box’ recommendations concerning tuberculosis. So far, postmarketing surveys revealed problems because course infectious be altered by therapy, critical importance consider this aspect care patients. evaluated series from institution which highlight difficulties