Risk of infection through use of selective immunomodulating drugs for rheumatoid arthritis
BACKGROUND: New drugs for rheumatoid arthritis (RA) have resulted in an improvement in patients' functioning and morbidity, but are linked with increased risk of infections. Traditional immunosuppressant drugs are often used in combination with anti-tumour necrosis factor-alpha (TNF-α) inhibitors or anti-CD20 (rituximab).
METHOD: The review is based on a search in PubMed and on the authors' own experience of treating infections in patients who receive immunosuppressant treatment.
RESULTS: Traditional immunomodulating treatment results in an increased risk of infection. The disease RA in itself increases the risk of infections. There is evidence of an increased incidence of infections with both extracellular bacteria and intracellular microorganisms such as mycobacteria, including Mycobacterium tuberculosis, and viruses in patients who are treated with TNF-α inhibitors. Patients who are about to start taking TNF-α inhibitors must therefore undergo a tuberculosis-risk assessment. Rituximab may increase the incidence of infection, but long-term observations are limited. Combination therapy involving different drugs that selectively modulate immune response is normally contraindicated because of the increased risk of infection.
INTERPRETATION: The benefit of TNF-α inhibitors and rituximab treatment for RA must be weighed up against the increased risk of infections. Symptoms, findings and laboratory test results pertaining to serious infections may be influenced by immunomodulation therapy and thereby make clinical assessment difficult.
| Errataetall: |
CommentIn: Tidsskr Nor Laegeforen. 2012 Oct 30;132(20):2259; author reply 2259. - PMID 23736187 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2012 |
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| Erschienen: |
2012 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:132 |
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| Enthalten in: |
Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke - 132(2012), 16 vom: 04. Sept., Seite 1867-71 |
| Sprache: |
Norwegisch |
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| Weiterer Titel: |
Infeksjonsrisiko ved bruk av selektivt immunmodulerende midler mot revmatoid artritt |
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| Beteiligte Personen: |
Harboe, Erna [VerfasserIn] |
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| Links: |
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| Themen: |
4F4X42SYQ6 |
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| Anmerkungen: |
Date Completed 03.12.2012 Date Revised 10.12.2019 published: Print CommentIn: Tidsskr Nor Laegeforen. 2012 Oct 30;132(20):2259; author reply 2259. - PMID 23736187 Citation Status MEDLINE |
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| doi: |
10.4045/tidsskr.12.0180 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 246 | 3 | 3 | |a Infeksjonsrisiko ved bruk av selektivt immunmodulerende midler mot revmatoid artritt |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: New drugs for rheumatoid arthritis (RA) have resulted in an improvement in patients' functioning and morbidity, but are linked with increased risk of infections. Traditional immunosuppressant drugs are often used in combination with anti-tumour necrosis factor-alpha (TNF-α) inhibitors or anti-CD20 (rituximab) | ||
| 520 | |a METHOD: The review is based on a search in PubMed and on the authors' own experience of treating infections in patients who receive immunosuppressant treatment | ||
| 520 | |a RESULTS: Traditional immunomodulating treatment results in an increased risk of infection. The disease RA in itself increases the risk of infections. There is evidence of an increased incidence of infections with both extracellular bacteria and intracellular microorganisms such as mycobacteria, including Mycobacterium tuberculosis, and viruses in patients who are treated with TNF-α inhibitors. Patients who are about to start taking TNF-α inhibitors must therefore undergo a tuberculosis-risk assessment. Rituximab may increase the incidence of infection, but long-term observations are limited. Combination therapy involving different drugs that selectively modulate immune response is normally contraindicated because of the increased risk of infection | ||
| 520 | |a INTERPRETATION: The benefit of TNF-α inhibitors and rituximab treatment for RA must be weighed up against the increased risk of infections. Symptoms, findings and laboratory test results pertaining to serious infections may be influenced by immunomodulation therapy and thereby make clinical assessment difficult | ||
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