The use of tumor necrosis factor-alpha (TNF-a) medications to treat spondylitis and rheumatoid arthritis is accompanied by an increased risk of tuberculosis and other opportunistic infections, concludes researchers from a 32-month retrospective study. Researchers Dominique Salmon, MD, Cochin Hospital in Paris, France, presented the findings at the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapies on September 14, 2003.

What They Found
Initially, Dr. Salmon and colleagues asked physicians across France to tell them of all opportunistic infections in patients receiving TNF-a medications between January 2000 and September 2002. One hundred seventy physicians reported 55 opportunistic infections, 25 of which were tuberculosis (TB), nine of other opportunistic bacterial infections, 17 viral infections, and four fungal infections.

Forty percent of the patients who developed TB were thought to have had latent tuberculosis, meaning that it had previously been in a dormant or hidden stage. Fifty five percent of the TB group developed TB that was at least partially extrapulmonary (meaning outside of, or having no relation to, the lungs).

They implied that the numbers are higher than would be expected for comparable patients being treated with other modalities (non TNF-a medications), although they did not supply comparative data supporting this notion.

Suggestions for Physicians
In conclusion, researchers caution that physicians need to be aware of otherwise unexpected opportunistic infections in their patients undergoing TNF-a treatment. Patients should be screened for latent TB before starting TNF-a therapy so that appropriate preventative or protective treatments for TB can be used when necessary.