Tuberculosis and Immune Reconstitution Inflammatory Syndrome in Patients With Inflammatory Bowel Disease and Anti-TNFα Treatment: Insights From a French Multicenter Study and Systematic Literature Review With Emphasis on Paradoxical Anti-TNFα Resumption

被引：0

作者：

Amoura, Ariane ^{[1
,2
]}

Frapard, Thomas ^{[3
,4
]}

Treton, Xavier ^{[5
]}

Surgers, Laure ^{[6
,7
]}

Beaugerie, Laurent ^{[8
]}

Lafaurie, Matthieu ^{[9
]}

Gornet, Jean Marc ^{[10
]}

Lepeule, Raphael ^{[11
]}

Amiot, Aurelien ^{[12
]}

Canoui, Etienne ^{[13
]}

Abitbol, Vered ^{[14
]}

Froissart, Antoine ^{[15
]}

Vidon, Mathias ^{[16
]}

Nguyen, Yann ^{[1
,17
]}

Lefort, Agnes ^{[1
,2
,17
]}

Zarrouk, Virginie ^{[1
]}

机构：

[1] Hop Beaujon, AP HP, Serv Med Interne, Clichy, France

[2] Univ Paris Cite, Grp Rech Infect Antimicrobials Modelling Evolut, Inserm, U1137, Paris, France

[3] Hop Henri Mondor, AP HP, Serv Med Intens & Reanimat, DHU ATVB, Creteil, France

[4] Univ Paris Est Creteil, Inst Mondor Rech Biomed, Fac Med Creteil, Grp Rech Clin CARMAS, Creteil, France

[5] Inst MICI, Grp Hosp pr Ambroise Pare Hartmann, Neuilly, France

[6] Sorbonne Univ, Hop St Antoine, AP HP, Serv Malad Infect & Trop, Paris, France

[7] Sorbonne Univ, Inst Pierre Louis Epidemiol & Sante Publ, INSERM, F-75012 Paris, France

[8] Hop St Antoine, AP HP, Serv Gastroenterol, Paris, France

[9] Hop Lariboisiere, Hop St Louis, AP HP, Serv Malad Infect & Trop, Paris, France

[10] Hop St Louis Hop, AP HP, Serv Gastroenterol, Paris, France

[11] Hop Univ Henri Mondor, AP HP, Unite Transversale Traitement Infect, Creteil, France

[12] Hop Henri Mondor, AP HP, Serv Gastroenterol, Creteil, France

[13] Hop Cochin, AP HP, Equipe Mobile Infectiol, CUP, Paris, France

[14] Univ Paris Cite, Hop Cochin, AP HP, Serv Gastroenterol, Paris, France

[15] Ctr Hosp Intercommunal Creteil, Serv Med Interne, Creteil, France

[16] Ctr Hosp Intercommunal Creteil, Serv Gastroenterol, Creteil, France

[17] Univ Paris Saclay, Ctr Rech Immunol Malad, INSERM, U1184, Le Kremlin Bicetre, France

来源：

OPEN FORUM INFECTIOUS DISEASES | 2024年 / 11卷 / 07期

关键词：

immune reconstitution inflammatory syndrome; infliximab; paradoxical reaction; TNF-alpha antagonists; tuberculosis; OPPORTUNISTIC INFECTIONS; THERAPY; INFLIXIMAB; RISK;

D O I：

10.1093/ofid/ofae327

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background The advent of anti-tumor necrosis factor alpha (anti-TNF alpha) has revolutionized the treatment of inflammatory bowel disease (IBD). However, susceptibility to active tuberculosis (TB) is associated with this therapy and requires its discontinuation. The risk of immune reconstitution inflammatory syndrome (IRIS) in this population is poorly understood, as is the safety of resuming anti-TNF alpha.Methods This French retrospective study (2010-2022) included all TB cases in patients with IBD who were treated with anti-TNF alpha in 6 participating centers. A systematic literature review was performed on TB-IRIS and anti-TNF alpha exposure.Results Thirty-six patients were included (median age, 35 years; IQR, 27-48). TB was disseminated in 86% and miliary in 53%. IRIS occurred in 47% after a median 45 days (IQR, 18-80). Most patients with TB-IRIS (93%) had disseminated TB. Miliary TB was associated with IRIS risk in univariate analysis (odds ratio, 7.33; 95% CI, 1.60-42.82; P = .015). Anti-TB treatment was longer in this population (median [IQR], 9 [9-12] vs 6 [6-9] months; P = .049). Anti-TNF alpha was resumed in 66% after a median 4 months (IQR, 3-10) for IBD activity (76%) or IRIS treatment (24%), with only 1 case of TB relapse. Fifty-two cases of TB-IRIS in patients treated with anti-TNF alpha were reported in the literature, complicating disseminating TB (85%) after a median 42 days (IQR, 21-90), with 70% requiring anti-inflammatory treatment. Forty cases of TB-IRIS or paradoxical reaction treated with anti-TNF alpha were also reported. IRIS was neurologic in 64%. Outcome was mostly favorable (93% recovery).Conclusions TB with anti-TNF alpha treatment is often complicated by IRIS of varying severity. Restarting anti-TNF alpha is a safe and effective strategy.

引用

页数：9

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