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Anti-TNF Monoclonal Antibody Therapy Linked to Tuberculosis

Last Updated: July 13, 2009.

Anti-tumor necrosis factor monoclonal antibody therapy is associated with a higher risk of tuberculosis than soluble TNF receptor therapy, according to research published in the July issue of Arthritis & Rheumatism.

MONDAY, July 13 (HealthDay News) Anti-tumor necrosis factor (anti-TNF) monoclonal antibody therapy is associated with a higher risk of tuberculosis than soluble TNF receptor therapy, according to research published in the July issue of Arthritis & Rheumatism.

Florence Tubach, M.D., of the Universite Paris, and colleagues analyzed data from a case-control study of 68 patients with tuberculosis who were treated with infliximab, adalimumab, or etanercept, and who were matched to patients without tuberculosis receiving anti-TNF treatment. The investigators also conducted an incidence study.

The researchers found that exposure to infliximab or adalimumab, compared to etanercept, was associated with higher risk of tuberculosis (odds ratio, 13.3). In terms of standardized incidence ratio (SIR), the risk of tuberculosis for patients on anti-TNF monoclonal antibody therapy compared with the French population differed by anti-TNF agent: the SIR was 1.8 for patients using etanercept, 18.6 for those on infliximab, and 29.3 for those on adalimumab.

"The mechanism by which TNF antagonists reactivate latent tuberculosis is not fully understood. In animal models, TNF plays a central role in mediating mycobacterial infections, and soluble TNF (especially membrane-bound TNF) expressed by activated macrophages and T lymphocytes is essential in protecting against tuberculosis infection. In a murine model of chronic tuberculosis, neutralization of TNF by antibody but not the TNF receptor fusion molecule exacerbated chronic tuberculosis because of better penetration of antibodies into granulomas," the authors write.

Several co-authors reported financial relationships with a number of pharmaceutical companies.

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