Infecciones severas en pacientes con artritis reumatoide tratados con fármacos antagonistas del factor de necrosis tumoral alfa

Authors

  • Marvin Sánchez Benavides Caja Costarricense del Seguro Social, Hospital Dr. Rafael A. Calderón Guardia
  • Adolfo Pacheco Salazar Caja Costarricense del Seguro Social, Hospital Dr. Rafael A. Calderón Guardia
  • Pablo Monge Zeledón Caja Costarricense del Seguro Social, Hospital México

DOI:

https://doi.org/10.51481/amc.v59i1.948

Keywords:

rheumatoid arthritis, antiTNF therapy, serious infections, epidemiology, diseasemodifying anti rheumatic drugs, prevalence

Abstract

Aim and objetives: the use of tumour necrosis factor alpha therapy antagonist leads to an increased risk of serious infections in rheumatoid arthritis, with a high morbi-mortality in clinical practice. There are no published data in our country. This study pretends to provide knowledge about the local epidemiology of serious infections and to identify associated risk factors.

Methods: An observational and retrospective study, included 50 patients treated at least for one year between 2006-2012. Demographic characteristics, clinical and epidemiological characteristics of serious infections and risk factors associated with serious infections were described.

Results: A predominant female population in middle age was detected. Just one serious infection was described, corresponding to serious skin and soft tissue infection that resolved with intravenousantibiotics. Risk factors were described including inmunosuppresive therapy with steroids and prior surgery.

Conclusions: Demographic profile of analized population and their clinic profile of serious infectios are similar to others populations. Low incidence of serious infections in this cohort could be related with less comorbilities than others populations, although, this topic needs further investigations to corroborate or discard this observation.

Downloads

Download data is not yet available.

References

Seymour HE, Worsley A, Smith JM, Thomas SHL. Anti TNFagents for rheumatoid arthritis. Br J Clin Pharmacol 2001; 51:201-208

Delgado-Vega AM, Martin J, Granados J, Anaya JM. Epidemiología genética de la artritis reumatoide ¿Qué esperar para América Latina? Biomédica 2006; 26:562-84

Carmona L, Villaverde V, Hernández-García C, Ballina J, Gabriel R, Lafon A, et al. The prevalence of rheumatoid arthritis in the general population of Spain. Rheumatology 2002; 41:88-95

Goh L, Jewell T, Laversuch T, Samantha A. A systematic review of the influence of anti-TNFon infection rates in patients with rheumatoid arthritis. Rev Bras Reumatol 2013; 53:501-515.

Dixon WG, Watson K, Lunt M, Hyrich KL, Silman AJ, Symmons DPM. Rates of serious infections, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumour necrosis factor therapy. Arthritis Rheum 2006; 54:2368-2376

Haroon N, Inman R. Infectious complications of biological therapy. Curr Opin Rheumatol 2009; 21:397-403

Listing J, Strangfeld A, Kary S, Rau R, Hinueber U, Stoyanova-Scholz M, et al. Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum 2005; 52:3403-3412

Ellerin T, Rubin RH, Weinblatt ME. Infections and anti-tumour necrosis factor ? therapy. Arthritis Rheum 2013; 48:3013-3022

Zuo JX, Braun J, Sieper J. Immunological basis for the use of TNF -blocking agents in ankylosing spondylitis and immunological changes during treatment. Clin Exp Rheumatol 2002; 20:S34-S37

Sacca R, Cuff C, Lesslauer W, Ruddle NH. Differential activities of secreted lymphotoxin-alpha3 and membrane lymphotoxin-alpha1beta2 in lymphotoxininduced inflammation: critical role of TNF receptor 1 signaling, J Immunol 1998; 160:485-491

Bazzoni F, Beutler B: The tumor necrosis factor ligand and receptor families, N Engl J Med 1996; 334:1717-1725

Feldman M, Elliot MJ, Woody JN, Maini RN. Anti-tumor necrosis factor-a therapy of rheumatoid arthritis. Adv Immunol 1997; 64:283-350

Martin-Mola E, Balsa A. Infectious complications of biologic agents. Rheum Dis Clin N Am 2009; 35:183-199

Kavanaugh A, Cohen S, Cush JJ. The evolving use of tumor necrosis factor inhibitors in rheumatoid arthritis. J Rheumatol 2004; 31:1881-1884

van Dartel SA, Fransen J, Kievit W, Dutmer EA, Brus HLM, Houtman NM et al. Predictors for the 5-year risk of serious infections in patients with rheumatoid arthritis treated with anti-tumour necrosis factor therapy: a cohort study in the Dutch rheumatoid Arthritis Monitoring (DREAM) registry. Rheumatology 2012; 52:1052-1057

Salmon-Ceron D, Tubach F, Lortholary O, Chosidow O, Bretagne S, Nicolas N, et al. Drug-specific of non-tuberculosis opportunistic infections in patients receiving anti-TNF therapy reported to the 3-year prospective French RATIO registry. Ann Rheum Dis 2011; 70:616-623

Baddley JW, Winthrop KL, Chen L, Liu L, Grijalva CG, Delzell E, et al. Nonviral opportunistic infections in new users of tumour necrosis factor inhibitor therapy: results of the Safety Assesment of Biologic Therapy (SABER) Study. Ann Rheum Dis 2013; 0:1-7

Askling J, Fored CM, Brandt L, Baecklund E, Bertilsson L, Feltelius L, et al. Time-dependent increase in risk of hospitalisation with infection among swedish RA patients treated with TNF antagonists. Ann Rheum Dis 2007; 66:1339-1344

Wallis RS. Biologics and infections: lessons from tumor necrosis factor blocking agents. Infect Dis Clin N Am 2011; 25:895-910

St. Claire EW, Wagner CL, Fasanmade AA, Wang B, Schaible T, Kavanaugh A et al. The relationship of serum infliximab concentrations to clinical improvement in rheumatoid arthritis: results from ATTRACT, a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2002; 46:1451-1459

Lipsky PE, van der Heijde D, St. Clair EW, Furst DE, Breedveld FC, Kalden, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med 2000; 343:1594-1602

Moreland LW, Schiff MH, Baumgartner SW, Tindall EA, Fleischmann RM, Bulpitt KJ et al. Etanercept therapy in rheumatoid arthritis. Ann Intern Med. 1999; 130:478-486

den Broeder AA, Joosten LAB, Saxne T, Heinegard D, Fenner H, Miltenburg AMM et al: Long term anti-tumour necrosis factor ? monotherapy in rheumatoid arthritis: effect on radiological course and prognostic value of markers of cartilage turnover and endothelial activation, Ann Rheum Dis 2002; 61:311-318

Lorenz HM, Antoni C, Valerius T, Repp R, Grunke M, Schwerdtner N, et al: In vivo blockade of TNF-? by intravenous infusion of a chimeric monoclonal TNF-? antibody in patients with rheumatoid arthritis: short term cellular and molecular effects, J Immunol 156:1646-1653, 1996

Charles P, Elliot MJ, Davis D, Potter A, Kalden JR, Antoni C et al. Regulation of cytokines, cytokine inhibitors, and acute-phase proteins following anti-TNF-? therapy in rheumatoid arthritis. J Inmunnol 1999; 163:1521-1528

Catrina AI, Lampa J, Ernestam S, af Klint E, Bratt J, Klareskog L et al. Anti tumour necrosis factor (TNF)-? therapy (etanercept) down-regulates serum matrix metalloproteinase (MMP)-3 and MMP-1 in rheumatoid arthritis. Rheumatology 2002; 41:484-489

Salliot C, Gossec L, Ruyssen-Witrand A, Luc M, Duclos M, Guignard M, et al. Infections during tumour necrosis factor ? blocker therapy for rheumatic disease in daily practice: a systematic retrospective study of 709 patients. Rheumatology 2007; 46:327-334

Bernatsky S, Habel Y, Rahme E. Observational studies of infections in rheumatoid arthritis: a metaanalisys of tumour necrosis factor antagonist. J Rheumatol 2010; 37:928-931

Galloway JB, Hyrich KL, Mercer LK, Dixon WG, Ustianowski AP, Helbert M, et al. Risk of septic arthritis in patients with rheumatoid arthritis and the effect of anti- TNF therapy: Results from the British Society for Rheumatology Biologics Register. Ann Rheum Dis 2011; 70:1810-1814

Patkar NM, Teng GG, Curtis JR, Saag KG. Association of infections and tuberculosis with antitumour necrosis factor alpha therapy. Curr Opin Rheumatol 2008; 20:320-326

Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. AntiTNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 2006; 295:2275-2285

Stenger S. Inmunological control of tuberculosis: rol of tumour necrosis factor and more. Ann Rheum Dis 2005; 64:iv24-iv28

Winthrop KL, Baxter R, Liu L, Varley CD, Curtis JR, Baddley JW, et al. Mycobacterial disease and antitumour necrosis factor therapy in USA. Ann Rheum Dis 2013; 72:37-42

Ali T, Kaitha S, Mahmood S, Ftesi A, Stone J, Bronze MS. Clinical use of antiTNF therapy and increased risk of infections. Drug, Healthcare and Patient Safety 2013; 5:79-99

Galloway JB, Mercer LK, Moseley A, Dixon WG, Uistianoswski AP, Helbert M, et al. Risk of skin and soft tissue infections (including shingles) in patients exposed to anti-tumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Ann Rheum Dis 2013; 72:229-234

Inanc N, Direskeneli H. Serious infections under treatment with TNF? antagonists compared to traditional DMARDs in patients with rheumatoid arthritis. Rheumatol Int 2006; 27:67-71

Doran MF, Crowson CS, Pond GR, O´Fallon WM, Gabriel SE. Frequency of infection in patients with heumatoid arthritis compared with controls. Arthritis

Rheum 2002; 46:2287-2293

Galloway JB, Hyrich KL, Mercer LK, Dixon WG, Fu B, Ustianowski AP, et al. Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: update results from the British Society for Rheumatology Biologics Register with special emphasis on risk in the erdely. Rheumatology 2011; 50:124-131

Greenberg J, Reed G, Decktor D. A comparative effectiveness study of adalimumab, etanercept and infliximab in biologically naive and switched rheumatoid arthritis patients: results from the US CORRONA registry. Ann Rheum Dis 2012;71:1134-1142

Kameda H, Ueki Y, Saito K. Etanercept (ETN) with methotrexate (MTX) is better than ETN monotherapy in patients with active rheumatoid arthritis despite MTX therapy: a randomized trial. Mod Rheumatol, 2010;20:531-538

Takeuchi T, Tanaka Y, Kaneko Y. Effectiveness and safety of adalimumab in Japanese patients with rheumatoid arthritis: retrospective analyses of data collected during the first year of adalimumab treatment in routine clinical practice (HARMONY study). Mod Rheumatol (2012) 22:327-338

Burmester G, Mariette X, Montecucco C. Adalimumab alone and in combination with disease-modifying antirheumatic drugs for the treatment of rheumatoid arthritis in clinical practice: the Research in Active Rheumatoid Arthritis (ReAct) trial. Ann Rheum Dis 2007;66:732-739

Singh J, Furst D, Bharat A. 2012 Update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care & Research Vol. 64, No. 5, May 2012, pp 625-639

Calabrese LH, Zein N, Vassilopoulosen D. Safety of antitumour necrosis factor (anti-TNF) therapy in patients with chronic viral infections: hepatitis C, hepatitis B, and HIV infection. Ann Rheum Dis 2004;63(Suppl II):ii18-ii24

Gonzales-Malaver F, Guzman-Vergara CM, Bello-Gualtero JM, Varela J, MesaBetancourt AM, Londoño J, et al. Latent tuberculosis infection and viral hepatitis in a Colombian cohort of patients with biological therapy. Ann Rheum Dis 2013 71:278

Nacci F, Matucci-Cerinic M. Tuberculosis and other infections in the antitumour necrosis factor-alpha (anti-TNF-?) era. Best Pract Res Clin Rheumatol.

Jun;25:375-88

Published

2017-02-01 — Updated on 2017-02-02

Versions

How to Cite

Infecciones severas en pacientes con artritis reumatoide tratados con fármacos antagonistas del factor de necrosis tumoral alfa. (2017). Acta Médica Costarricense , 59(1), 15-21. https://doi.org/10.51481/amc.v59i1.948 (Original work published 2017)