δείτε την πρωτότυπη σελίδα τεκμηρίου στον ιστότοπο του αποθετηρίου του φορέα για περισσότερες πληροφορίες και για να δείτε όλα τα ψηφιακά αρχεία του τεκμηρίου*
Tuberculosis and targeted synthetic or biologic DMARDs, beyond tumor
necrosis factor inhibitors
Evangelatos, Gerasimos
Koulouri, Vasiliki
Iliopoulos, Alexios
and Fragoulis, George E.
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.
(EN)
*Η εύρυθμη και αδιάλειπτη λειτουργία των διαδικτυακών διευθύνσεων των συλλογών (ψηφιακό αρχείο, καρτέλα τεκμηρίου στο αποθετήριο) είναι αποκλειστική ευθύνη των αντίστοιχων Φορέων περιεχομένου.
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