Información del artículo
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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Bibliografía
[1.]
Global tuberculosis control: epidemiology, strategy, financing: WHO report 2009 Disponible en: www.who.int/tb/publications/global_report/2009
[2.]
R.M. Jasmer, P. Nahid, P.C. Hopewell.
Latent tuberculosis infection.
N Eng J Med, 347 (2002), pp. 1860-1866
[3.]
E. Rodríguez, G. Hernández, O. Díaz, O. Tello.
Casos de tuberculosis declarados a la Red Nacional de Vigilancia Epidemiológica. España, 2007. Boletín Epidemiológic?.
Semanal, 16 (2008), pp. 229-240
[4.]
Annual Epidemiological Report on communicable diseases in Europe 2008 Disponible en: www.ecdc.europa.eu/en/publications/Publications/0812_SUR_Annual_Epidemiological_Report_2008
[5.]
J. Keane, S. Gershon, R.P. Wise, E. Mirabile-Levens, E. Mirabile-Levens, J. Kasznica, et al.
Tuberculosis associated with infliximab, a tumor necrosis factor α-neutralizing agent.
N Engl J Med, 345 (2001), pp. 1098-1104
[6.]
J.J. Gómez-Reino, L. Carmona, V.R. Valverde, E.M. Mola, M.D. Montero, BIODATABASER Group.
Treatment of rheumatoid arthritis with tumor necrosis factors inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report.
Arthritis Rheum, 48 (2003), pp. 2122-2127
[7.]
F. Wolfe, K. Michaud, J. Anderson, K. Urbansky.
Tuberculosis in patients with rheumatoid arthritis and the effect of infliximab therapy.
Arthritis Rheum, 50 (2004), pp. 372-379
[8.]
A.K. Mohan, T.R. Coté, J.A. Block, A.M. Manadan, J.N. Siegel, M.M. Braun.
Tuberculosis following the use of etanercept, a tumor necrosis factor inhibitor.
Clin Infect Dis, 39 (2004), pp. 295-299
[9.]
R.S. Wallis, M.S. Broder, J.Y. Wong, M.E. Hanson, D.O. Beenhouwer.
Granulomatous infectious due to tumor necrosis factor blockage: correction.
Clin Infect Dis, 39 (2004), pp. 1254-1256
[10.]
K.L. Winthrop, J.N. Siegel, J. Jereb, Z. Taylor, M.F. Iademarco.
Tuberculosis associated with therapy against tumor necrosis factor a.
Arthritis Rheum, 52 (2005), pp. 2968-2974
[11.]
J. Askling, C.M. Fored, L. Brandt, E. Baecklund, L. Bertilsson, L. Cöster, et al.
Risk and case characteristic of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden.
Arthritis Rheum, 52 (2005), pp. 1986-1992
[12.]
B. Baldin, A. Dozol, A. Spreux, R.M. Chicmanian.
Tuberculosis and infliximab treatment.
Press Med, 34 (2005), pp. 353-357
[13.]
F. Tubach, D. Salmon-Ceron, P. Ravaud.
The RATIO observatory: French registry of opportunistic infections, severe bacterial infections and lymphomas complicating anti-TNF alpha therapy.
Joint Bone Spine, 72 (2005), pp. 456-460
[14.]
R.S. Wallis, M.S. Broder, J. Wong, A. Lee, L. Hoq.
Reactivation of latent tuberculosis infections by infliximab.
Clin Infect Dis, 41 (2005), pp. S194-S198
[15.]
J.E. Fonseca, H. Canhao, C. Silva.
Tuberculosis in rheumatic patients treated with tumour necrosis factor alpha antagonists: the Portuguese experience.
Acta Reumatol Port, 31 (2006), pp. 247-253
[16.]
P. Brassad, A. Kezouh, S. Susisa.
Antirheumatic drugs and the risk of tuberculosis.
Clin Infect Dis, 43 (2006), pp. 717-722
[17.]
W.G. Dixon, M. Watson, M. Lunt, K.L. Hyrich, A.J. Silman, D.P. Symmons, British Society for Rheumatology Biologics Register.
Rates of serious infection including site-specific and bacterial intracellular infection, in rheumatoid artritis patients receiving anti-tumor necrosis factor therapy: results from the British Socie ty for Rheumatology biologics register.
Arthritis Rheum, 54 (2006), pp. 2238-2276
[18.]
A. Rojas-Villarraga, C.A. Agudelo, R. Pineda-Tamayo, A. Porras, G. Matute, J.M. Anaya.
Tuberculosis in patients treated with tumor necrosis factor-alpha antagonists living in an endemic area. Is the risk worthwhile.
Biomedica, 27 (2007), pp. 159-171
[19.]
K.L. Winthrop, S. Yamashita, E. Beekmann, P.M. Polgreen.
Mycobacterial and other serious infections in patients receiving anti-tumor necrosis factor and other newly approved biologic therapies: case finding through the emerging infections network.
Clin Infect Dis, 46 (2008), pp. 1838-1840
[20.]
G. Kitamura, N. Mehr, N. Anderson, M. Sirichotiratana.
A case of tuberculosis in a patient on Efalizumab and etanercept for treatment of refractory palmopustular psoriasis and psoriatic arthritis.
Dermatol Online J, 15 (2009), pp. 11
[21.]
A. Perlmutter, A. Mittal, A. Menter.
Tuberculosis and tumour factor- α inhibitor therapy: A report of three cases in patients with psoriasis. Comprehensive screening and therapeutic guidelines for clinicians.
Br J Dermatol, 160 (2009), pp. 8-15
[22.]
O. Elbek, M. Uyar, N. Aydin, S. Börekci, N. Bayram, H. Bayram, et al.
Increased risk of tuberculosis in patients treated with antitumor necrosis factor alpha.
Clin Rheumatol, 28 (2009), pp. 421-426
[23.]
J.W. Dharamsi, M. Bhosle, R. Balkrishanan, B.A. Yentzer, S.R. Feldman.
Using “number needed to treat” to help conceptualize the magnitude of benefit and risk of tumour necrosis factor-α inhibitors for patients with severe psoriasis.
Br J Dermatol, 161 (2009), pp. 605-616
[24.]
J.A. Caminero, M. Casal, V. Auxina, J.M. Pina, J. Sauret.
Recomendaciones SEPAR. Diagnóstico de la tuberculosis.
Arch Bronconeumol, 32 (1996), pp. 85-99
[25.]
R.S. Wallis.
Tumour necrosis factor antagonists: structure, function and tuberculosis risks.
Lancet Infect Dis, 8 (2008), pp. 601-611
[26.]
S.D. Chakravarty, G. Shu, M.C. Tsai, V.P. Mohan, S. Marino, D.E. Kirschner, et al.
Tumor necrosis factor blockade in chronic murine tuberculosis enhances granulomatous inflammation and disorganizes granulomas in the lungs.
Infect Immun, 76 (2008), pp. 916-926
[27.]
T. Botha, B. Rifle.
Reactivation of latent tuberculosis infection in TNF-deficient mice.
J Immunol, 171 (2003), pp. 3110-3118
[28.]
M.A. Gardam, E.C. Keystone, R. Menzies, S. Mannere, E. Skamene, R. Long, et al.
Anti-tumour necrosis factor agents and tuberculosis risk; mechanism of action and clinical management.
Lancet Infect Dis, 3 (2003), pp. 148-155
[29.]
H.L. Plessner, L. Lin, T. Kohno, J.S. Louie, D. Kirschner, J. Chan, et al.
Neutralization of tumor necrosis factor (TNF) by antibody but not TNF receptor fusion molecule exacerbates chronic murine tuberculosis.
J Infect Dis, 195 (2007), pp. 1643-1650
[30.]
F. Tubach, D. Salmon, P. Ravaud, Y. Allanore, P. Goupille, M. Bréban, et al.
Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy.
Arthritis Rheum, 60 (2009), pp. 1884-1894
[31.]
J. Wajdula, D. MacPeek, S. Lin, S. Hamza, S. Fatenejad.
Incidence of tuberculosis is low in patients receiving etanercept therapy for the treatment of rheumatoid arthritis: results from a combined analysis of US and exUS double-blind trials and their open label extensions.
Ann Rheum Dis, 66 (2007), pp. 195
[32.]
D.E. Furst, R. Wallis, M. Broker, D.O. Beenhouwer.
Tumor necrosis factor antagonist: different kinetics and/or mechanisms of action may explain differences in the risk for developing granulomatous infection.
Sem Arthritis Rheum, 36 (2006), pp. 159-167
[33.]
O.Y. Saliu, C. Soler, D.S. Stein, S.K. Schwander, R.S. Wallis.
Tumornecrosis-factor blockers: differential effects on mycobacterial immunity.
J Infect Dis, 194 (2006), pp. 486-492
[34.]
R.S. Wallis.
Reactivation of tuberculosis by TNF blockade: the role of interferon γ.
J Invest Dermatol Symp Proc, 12 (2007), pp. 16-21
[35.]
J. Harris, J.C. Hope, J. Keane.
Tumour necrosis factor blockers influence macrophage responses to mycobacterium tuberculosis.
J Infect Dis, 198 (2008), pp. 1-9
[36.]
R.S. Wallis.
Matematical modeling of the cause of tuberculosis during tumor necrosis factor blockade.
Arthritis Rheum, 58 (2008), pp. 947-952
[37.]
L. Carmona, J.J. Gómez-Reino, V. Rodríguez-Valverde, D. Montero, E. Pascual-Gómez, E.M. Mola, et al.
Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists.
Arthritis Rheum, 52 (2005), pp. 1766-1772
[38.]
J.L. Pérez.
Impact of screening for latent TB prior to initiation antiTNF therapy in North America and Europe.
Ann Rheum Dis, 64 (2005), pp. 86
[39.]
J.J. Gómez-Reino, L. Carmona, M. Ángel Descalzo, Biobadaser Group.
Risk of tuberculosis in patients treated with tumor necrosis factor antagonists due to incomplete prevention of reactivation of latent infection.
Arthritis Rheum, 57 (2007), pp. 756-761
[40.]
H. John, C. Buckley, L. Koh, K. Obrenovic, N. Erb, I.F. Rowe, West Midlands Rheumatology Service and Training Committee.
Regional survey of tuberculosis risk assessment in rheumatology outpatients commencing anti-TNF-α treatment in relation to British Thoracic Society guidelines.
Clin Med, 9 (2009), pp. 225-230
[41.]
J. Ruiz-Manzano, R. Blanquer, J.L. Calpe, J.A. Caminero, J. Caylà, J.A. Domínguez, et al.
Normativa SEPAR: diagnóstico y trata miento de la tuberculosis.
Arch Bronconeumol, 44 (2008), pp. 551-566
[42.]
D. Menzies, M. Pai, G. Comstock.
Meta-analysis: new test for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research.
Ann Intern Med, 146 (2007), pp. 340-354
[43.]
M. Pai, A. Zwerling, D. Menzies.
Systematic review; T-cell-based assays for the diagnosis of latent tuberculosis infection: an update.
Ann Intern Med, 149 (2008), pp. 177-184
[44.]
K. Higuchi, N. Harad, K. Fukazawa, T. Mori.
Relationship between whole-blood interferon-gamma responses and the risk of active tuberculosis.
Tuberculosis, 88 (2008), pp. 244-248
[45.]
E.M. Leyten, S.M. Arend, C. Prins, F. Cobelens, T.H. Ottenhoff, J.T. van Dissel.
Discrepancy between Mycobacterium tuberculosis-specific gamma interferon release assays using short and prolonged in vitro incubation.
Clin Vaccine Immunol, 14 (2007), pp. 880-885
[46.]
H.H. Oon, W.S. Chong, C.F. Liew.
Indeterminate results on the interferon- γ release assay for tuberculosis screening should not be ignored.
Br J Dermatol, 159 (2008), pp. 979-995
[47.]
G. Ferrara, M. Losi, R. D’Amico, P. Roversi, R. Piro, M. Meacci, et al.
Use in routine clinical practice of two comercial blood tests for diagnosis of infection with Mycobacterium tuberculosis: a prospective study.
Lancet, 367 (2006), pp. 1328-1334
[48.]
F. Piana, L. Ruffo Codecasa, R. Baldan, P. Miotto, M. Ferrarese, D.M. Cirillo.
Use of T-SPOT.TB in latent tuberculosis infection diagnosis in general and immunosuppressed populations.
New Microbiol, 30 (2007), pp. 286-290
[49.]
D. Ponce de León, Acevedo-Vásquez, S. Alzivuri, C. Gutiérrez, M. Cucho, J. Alfaro, et al.
Comparison of an interferon-γ assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population.
J Rheumatol, 35 (2008), pp. 776-781
[50.]
D. Vassilopoulos, N. Stamoulis, E. Hadziyannis, A.J. Archimandritis.
Usefulness of enzyme.linked immunospot assay (Elispot) compared to tuberculin skin testing for latent tuberculosis screening in rheumatic patients scheduled for anti-tumor necrosis factor treatment.
J Rheumatol, 35 (2008), pp. 1271-1276
[51.]
S.M. Behar, D.S. Shin, A. Maier, J. Coblyn, S. Helfgott, M.E. Weinblatt.
Use of the T-SPOT.TB assay to detect latent tuberculosis infection among rheumatic disease patients on immunosuppressive therapy.
J Rheumatol, 36 (2009), pp. 546-551
[52.]
G. Matulis, P. Juni, P.M. Villiger, S.D. Gadola.
Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a Mycobacterium tuberculosis antigen- specific interferon γ assay.
Ann Rheum Dis, 67 (2008), pp. 84-90
[53.]
E. Laffitte, J.P. Janssens, P. Roux-Lombard, A.M. Thielen, C. Barde, G. Marazza, et al.
Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: comparison of an interferon-gamma release assay vs. tuberculin skin test.
Br J Dermatol, 161 (2009), pp. 797-800
[54.]
X. Mariette, D. Salmon, Group RATIO.
French guidelines for diagnosis and treating latent and active tuberculosis in patients with RA treated with TNF blockers.
Ann Rheum Dis, 62 (2003), pp. 791-792
[55.]
Centers for Disease Control and Prevention.
Tuberculosis associated with blockling agents against tumor necrosis factor-alpha. California 2002-2003.
MMWR Morb Mortal Wkly Rep, 53 (2004), pp. 683-686
[56.]
British Thoracic Society Standards of Care Committee.
BTS guidelines for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti- TNF-α treatment.
Thorax, 60 (2005), pp. 800-805
[57.]
L. Puig, X. Bordas, J.M. Carrascosa, E. Daudén, C. Ferrándiz, J.M. Hernanz, et al.
Documento de consenso sobre la evaluación y el tratamiento de la psoriasis moderada/grave del Grupo Español de Psoriasis de la Academia Española de Dermatología y Venereología.
Actas Dermosifiliogr, 100 (2009), pp. 277-286
[58.]
C. Beglinger, J. Dudler, C. Mottet, L. Nicod, F. Seibold, P.M. Villiger, et al.
Screening for tuberculosis infection before initiation of anti-TNF-α therapy.
Swiss Med Wkly, 137 (2007), pp. 621-622
[59.]
A. Gupta, A.C. Street, A. Macrae.
Tumor necrosis factor a inhibitors: screening for tuberculosis infection in inflammatory bowel disease.
MJA, 188 (2008), pp. 168-170
[60.]
Canadian Tuberculosis Committee.
Updated recommendations on interferon gamma release assays for latent tuberculosis infection.
Can Commun Dis Rep, 34 (2008), pp. 1-13
[61.]
K.L. Winthrop, T. Chiller.
Preventing and treating biologic-associated opportunistic infections.
Nat Rev Rheumatol, 5 (2009), pp. 405-410
[62.]
R. Diel, B. Hauer, R. Loddenkemper, B. Manger, K. Krüger.
Recommendations for tuberculosis screening before initiation of TNF-alpha-inhibitor treatment in rheumatic diseases.
Z Rheumatol, 68 (2009), pp. 411-416
[63.]
A. Lalvani, K.A. Millington.
Screening for tuberculosis infection prior to initiation of antiTNF therapy.
Autoimmun Rev, 8 (2008), pp. 147-152
[64.]
A. Naseer, S. Naqvi, B. Kampmannn.
Evidence for boosting Mycobacterium tuberculosis-specific INF-gamma responses at 6 weeks following skin test.
Eur Respir J, 29 (2007), pp. 1282-1283
[65.]
S.D. Doherty, A.V. Van Voorhees, M.G. Lebwohl, N.J. Korman, N.J. Korman, M.S. Young, et al.
Nacional Psoriasis Fundation consensus statement on screening for latent tuberculosis infection in patients with psoriasis treated with systemic and biologic agents.
J Am Acad Dermatol, 59 (2008), pp. 209-217
[66.]
B. Strober, E. Berger, J. Cather, D. Cohen, J.J. Crowley, K.B. Gordon, et al.
A series of critically challenging case scenarios in modera te to severe psoriasis: A Delphi consensus approach.
J Am Acad Dermatol, 61 (2009), pp. S1-S46
[67.]
D. Cooray, R. Moran, D. Khanna, H. Paulus, J. Louie, D. Furst, et al.
Screening, re-screen ing and treatment of PPD positivity in patients on anti-TNF-alpha therapy.
Arthritis Rheum, 58 (2008), pp. S546-S547
[68.]
W. Sumner, S.R. Feldman.
Conversion to positive test during etanercept treatment of psoriasis.
J Drugs Dermatol, 6 (2007), pp. 1048
[69.]
G.W. Comstock.
How much isoniazid is hended for prevention of tuberculosis among immunocompetent adults?.
Int J Tuberc Lung Dis, 3 (1999), pp. 847-850
[70.]
M. Smieja, C. Marchetti, D. Cook, F.M. Smaill.
Isoniazid for preventing tuberculosis in non-HIV persons.
Cochrane Database Syst Rev, (2000),
[71.]
L. Sichletidis, L. Settas, D. Spyratos, D. Chloros, D. Patakas.
Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis.
Int J Tuberc Lung Dis, 10 (2006), pp. 1127-1132
[72.]
R.S. Wallis.
Infectious complications of tumor necrosis factor blockade.
Curr Opin Infect Dis, 22 (2009), pp. 403-409
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