Drug-specific risk of non-tuberculosis opportunistic infections in patients receiving anti-TNF therapy reported to the 3-year prospective French RATIO registry

• DOI: 10.1136/ard.2010.137422
• Publication Date: 2010-12-22T02:12:00Z
• Authors: D Salmon-Ceron; F Tubach; O Lortholary; O Chosidow; S Bretagne; N Nicolas; E Cuillerier; B Fautrel; C Michelet; J Morel; X Puéchal; D Wendling; M Lemann; P Ravaud; X Mariette
• Keywords: Adult; Male; MESH: Antirheumatic Agents; Anti-Inflammatory Agents; Opportunistic Infections; MESH: Epidemiologic Methods; Antibodies, Monoclonal, Humanized; Receptors, Tumor Necrosis Factor; MESH: Antibodies, Monoclonal; Etanercept; 03 medical and health sciences; 0302 clinical medicine; [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases; Humans; Immunologic Factors; Aged; MESH: Aged; MESH: Immunoglobulin G; MESH: Middle Aged; MESH: Humans; Tumor Necrosis Factor-alpha; MESH: Immunologic Factors; Adalimumab; Antibodies, Monoclonal; MESH: Adult; MESH: Opportunistic Infections; Middle Aged; MESH: Receptors, Tumor Necrosis Factor; MESH: Male; Infliximab; 3. Good health; MESH: France; MESH: Antibodies, Monoclonal, Humanized; MESH: Tumor Necrosis Factor-alpha; MESH: Anti-Inflammatory Agents; Antirheumatic Agents; Immunoglobulin G; [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases; Female; France; Epidemiologic Methods; MESH: Female

Background Anti-tumour necrosis factor (TNF) therapy may be associated with opportunistic infections (OIs). Objective To describe the spectrum of non-tuberculosis OIs anti-TNF and identify their risk factors. Methods A 3-year national French registry (RATIO) collected all cases OI in patients receiving treatment for any indication France. case–control study was performed three controls treated agents per case, matched gender underlying inflammatory disease. Results 45 were non-TB 43 infliximab (n=29), adalimumab (n=10) or etanercept (n=4) rheumatoid arthritis (n=26), spondyloarthritides (n=3), colitis (n=8), psoriasis (n=1) other conditions (n=5). One-third (33%) bacterial (4 listeriosis, 4 nocardiosis, atypical mycobacteriosis, 3 non-typhoid salmonellosis), 40% viral (8 severe herpes zoster, varicella, extensive simplex, disseminated cytomegalovirus infections), 22% fungal (5 pneumocystosis, invasive aspergillosis, 2 cryptococcosis) 4% parasitic (2 leishmaniasis). Ten (23%) required admission to intensive care unit, four (9%) died. Risk factors (OR=17.6 (95% CI 4.3 - 72.9); p<0.0001)or (OR=10.0 (2.3 44.4); p=0.002) versus etanercept, oral steroid use >10 mg/day intravenous boluses during previous year (OR=6.3 (2.0 20.0); p=0.002). Conclusion Various OIs, especially those intracellular micro-organisms, develop treatment. Monoclonal antibody rather than soluble TNF receptor are independently OI.