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Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors
Patients with autoimmune rheumatic diseases (ARD) have an increased risk for tuberculosis (TB). The use of tumor necrosis factor inhibitors (TNFi) and glucocorticoids in these patients has been associated with an increased prevalence of latent TB reactivation. Over the last few years, several biolog...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309385/ https://www.ncbi.nlm.nih.gov/pubmed/32612710 http://dx.doi.org/10.1177/1759720X20930116 |
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author | Evangelatos, Gerasimos Koulouri, Vasiliki Iliopoulos, Alexios Fragoulis, George E |
author_facet | Evangelatos, Gerasimos Koulouri, Vasiliki Iliopoulos, Alexios Fragoulis, George E |
author_sort | Evangelatos, Gerasimos |
collection | PubMed |
description | Patients with autoimmune rheumatic diseases (ARD) have an increased risk for tuberculosis (TB). The use of tumor necrosis factor inhibitors (TNFi) and glucocorticoids in these patients has been associated with an increased prevalence of latent TB reactivation. Over the last few years, several biologic disease-modifying anti-rheumatic drugs (bDMARDs), other than TNFi (e.g. rituximab, abatacept, tocilizumab, secukinumab) and targeted synthetic DMARDs (tsDMARDs) [e.g. apremilast, Janus kinase (JAK) inhibitors] have been used for the treatment of patients with ARD. For many of these drugs, especially the newer ones like JAK inhibitors or antibodies against interleukin (IL)-23, most data stem from randomized clinical trials and few are available from real life clinical experience. We sought to review the current evidence for TB risk in patients with ARD treated with tsDMARDs or bDMARDs, other than TNFi. It seems that some of these drugs are associated with a lower TB risk, indirectly compared with TNFi treatment. In fact, it appears that rituximab, apremilast and inhibitors of IL-17 and IL-23 might be safer, while more data are needed for JAK inhibitors. As seen in TNFi, risk for TB is more pronounced in TB-endemic areas. Screening for latent TB must precede initiation of any tsDMARDs or bDMARDs. The growing use of non-TNFi agents has raised the need for more real-life studies that would compare the risk for TB between TNFi and other treatment modalities for ARD. Knowledge about the TB-safety profile of these drugs could help in the decision of drug choice in patients with confirmed latent TB infection or in TB endemic areas. |
format | Online Article Text |
id | pubmed-7309385 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-73093852020-06-30 Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors Evangelatos, Gerasimos Koulouri, Vasiliki Iliopoulos, Alexios Fragoulis, George E Ther Adv Musculoskelet Dis When Rheumatology and Infectious Disease Come Together Patients with autoimmune rheumatic diseases (ARD) have an increased risk for tuberculosis (TB). The use of tumor necrosis factor inhibitors (TNFi) and glucocorticoids in these patients has been associated with an increased prevalence of latent TB reactivation. Over the last few years, several biologic disease-modifying anti-rheumatic drugs (bDMARDs), other than TNFi (e.g. rituximab, abatacept, tocilizumab, secukinumab) and targeted synthetic DMARDs (tsDMARDs) [e.g. apremilast, Janus kinase (JAK) inhibitors] have been used for the treatment of patients with ARD. For many of these drugs, especially the newer ones like JAK inhibitors or antibodies against interleukin (IL)-23, most data stem from randomized clinical trials and few are available from real life clinical experience. We sought to review the current evidence for TB risk in patients with ARD treated with tsDMARDs or bDMARDs, other than TNFi. It seems that some of these drugs are associated with a lower TB risk, indirectly compared with TNFi treatment. In fact, it appears that rituximab, apremilast and inhibitors of IL-17 and IL-23 might be safer, while more data are needed for JAK inhibitors. As seen in TNFi, risk for TB is more pronounced in TB-endemic areas. Screening for latent TB must precede initiation of any tsDMARDs or bDMARDs. The growing use of non-TNFi agents has raised the need for more real-life studies that would compare the risk for TB between TNFi and other treatment modalities for ARD. Knowledge about the TB-safety profile of these drugs could help in the decision of drug choice in patients with confirmed latent TB infection or in TB endemic areas. SAGE Publications 2020-06-22 /pmc/articles/PMC7309385/ /pubmed/32612710 http://dx.doi.org/10.1177/1759720X20930116 Text en © The Author(s), 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | When Rheumatology and Infectious Disease Come Together Evangelatos, Gerasimos Koulouri, Vasiliki Iliopoulos, Alexios Fragoulis, George E Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors |
title | Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors |
title_full | Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors |
title_fullStr | Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors |
title_full_unstemmed | Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors |
title_short | Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor necrosis factor inhibitors |
title_sort | tuberculosis and targeted synthetic or biologic dmards, beyond tumor necrosis factor inhibitors |
topic | When Rheumatology and Infectious Disease Come Together |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309385/ https://www.ncbi.nlm.nih.gov/pubmed/32612710 http://dx.doi.org/10.1177/1759720X20930116 |
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