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https://hdl.handle.net/2440/63215
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Type: | Journal article |
Title: | Serious infections in patients with inflammatory bowel disease receiving anti-tumor-necrosis-factor-alpha therapy: An Australian and New Zealand experience |
Author: | Lawrance, I. Radford-Smith, G. Bampton, P. Andrews, J. Tan, P. Croft, A. Gearry, R. Florin, T. |
Citation: | Journal of Gastroenterology and Hepatology, 2010; 25(11):1732-1738 |
Publisher: | Blackwell Publishing Asia |
Issue Date: | 2010 |
ISSN: | 0815-9319 1440-1746 |
Statement of Responsibility: | Ian C Lawrance, Graham L Radford-Smith, Peter A Bampton, Jane M Andrews, Pok-Kern Tan, Anthony Croft, Richard B Gearry and Timothy H J Florin |
Abstract: | <h4>Background and aim</h4>Anti-tumor-necrosis-factor-alpha (anti-TNF-α) medications are effective in inflammatory bowel disease (IBD), but have an increased risk of tuberculosis (TB) and serious infections. The aim of this study was to examine the Australian/New Zealand experience of serious infections and TB in IBD patients receiving anti-TNF-α therapy from 1999-2009.<h4>Methods</h4>Serious infections, defined as 'requiring hospital admission' and TB cases in patients receiving, or within 3 months following, anti-TNF-α therapy were analyzed across Australia and New Zealand. Patient demographics, IBD medications, duration of anti-TNF-α therapy, and infection details were collected.<h4>Results</h4>A total of 5562 IBD patients were managed across the centers. Of these, 489 (16.8%) Crohn's disease and 137 (5.2%) ulcerative colitis patients received anti-TNF-α therapy. There were three cases of latent TB that received prophylaxis prior to anti-TNF-α therapy. No cases of active TB were reported. Fourteen (2.2%) serious infections occurred. Seven occurred in patients receiving anti-TNF-α therapy for less than 6 months, including two cases of primary Varicella zoster (VZV), two cases of Pneumocystis jiroveci pneumonia, two cases of Staphylococcus aureus bacteremia, and one severe flu-like illness. Six patients were taking additional immunosuppressive medications. The other seven infections occurred after 6 months (mean 32.6 ± 24.3 months) and included one case of primary VZV, one flu-like illness, and five bacterial infections. All infections resolved with treatment.<h4>Conclusion</h4>TB is a very rare complication of anti-TNF-α therapy in Australia and New Zealand. Serious infections are uncommon but early opportunistic infections with Pneumocystis jiroveci pneumonia suggest a need for vigilance in patients on multiple immunosuppressive medications. VZV vaccination prior to immunosuppressive therapy should be considered in VZV-naïve patients. |
Keywords: | anti-tumor-necrosis-factor-alpha medication Crohn’s Disease infection inflammatory bowel disease ulcerative colitis. |
Rights: | © 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd. |
DOI: | 10.1111/j.1440-1746.2010.06407.x |
Published version: | http://dx.doi.org/10.1111/j.1440-1746.2010.06407.x |
Appears in Collections: | Aurora harvest 5 Medicine publications |
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