Article information
Resumen
Los fármacos que bloquean el factor de necrosis tumoral α (TNF-α) aumentan el riesgo de reactivación de infección latente tuberculosa (ILT). El riesgo es mayor con los anticuerpos monoclonales que con etanercept.
Para reducir este riesgo se recomienda realizar el cribado de infección latente tuberculosa previo al inicio del tratamiento. El cribado incluye una historia clínica completa, exploración física, prueba de tuberculina, detección in vitro de producción de interferón-γ (INF-γ) y radiología de tórax. Las limitaciones de las distintas pruebas deben ser tenidas en cuenta por el médico. Tras el diagnóstico de infección latente tuberculosa el paciente ha de recibir tratamiento con isoniacida durante 9 meses.
A pesar de un cribado y tratamiento adecuados de la ILT los pacientes en terapia con fármacos anti-TNF-α pueden desarrollar tuberculosis activa. Por tanto, debe realizarse seguimiento clínico de los mismos para detectar signos de tuberculosis activa con cuadros atípicos y disemi nados.
Palabras clave:
Factor de necrosis tumoral alfa
Etanercept
Tuberculosis
Abstract
Drugs that block the tumor necrosis factor α (TNFα) increase the risk of reactivation of latent tuberculosis infection (LTI). The risk is greater with monoclonal antibodies than with etanercept.
In order to reduce this risk, screening of latent tuberculosis infection should be performed prior to the initiation of the treatment. Screening includes a complete clinical history, physical examination, tuberculin test, in vitro detection of interferon-γ (INFγ) production and a chest x-ray. The limitations of the different tests should be taken into consideration by the physician. After the diagnosis of latent tuberculosis infection, the patient must receive treatment with isoniacide for 9 months.
In spite of screening and adequate treatment of latent tuberculosis treatment, the patients receiving treatment with anti-TNFα drugs may develop active tuberculosis. Thus, the patient should undergo clinical follow-up to detect signs of active tuberculosis with atypical and disseminated pictures.
Keywords:
Alpha tumor necrosis factor
Etanercept
Tuberculosis
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