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The Risk of tuberculosis related to tumour necrosis factor antagonist therapies: a TBNET consensus statement

Solovic, Ivan and Sester, Martina and Gómez Reino, Juan J. and Rieder, Hans L. and Ehlers, S. and Milburn, Heather J. and Kampmann, Beate and Hellmich, Bernhard and Groves, R. and Schreiber, Stefan and Wallis, Robert S. and Sotgiu, Giovanni and Schölvinck, Elisabeth H. and Goletti, Delia and Zellweger, Jean-Pierre and Diel, R. and Carmona, Loreto and Bartalesi, Filippo and Ravn, P. and Bossink, Aik and Duarte, R. and Erkens, Connie and Clark, J. and Migliori, Giovanni Battista and Lange, Christoph (2010) The Risk of tuberculosis related to tumour necrosis factor antagonist therapies: a TBNET consensus statement. European Respiratory Journal, Vol. 36 (5), p. 1185-1206. eISSN 1399-3003. Article.

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DOI: 10.1183/09031936.00028510

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Abstract

Anti-tumour necrosis factor (TNF) monoclonal antibodies or soluble TNF receptors have become an invaluable treatment against chronic inflammatory diseases, such as rheumatoid arthritis, inflammatory bowel disease and psoriasis. Individuals who are treated with TNF antagonists are at an increased risk of reactivating latent infections, especially tuberculosis (TB).
Following TNF antagonist therapy, the relative risk for TB is increased up to 25 times, depending on the clinical setting and the TNF antagonist used. Interferon-γ release assays or, as an alternative in individuals without a history of bacille Calmette–Guérin vaccination, tuberculin skin testing is recommended to screen all adult candidates for TNF antagonist treatment for the presence of latent infection with Mycobacterium tuberculosis.
Moreover, paediatric practice suggests concomitant use of both the tuberculin skin test and an interferon-γ release assay, as there are insufficient data in children to recommend one test over the other. Consequently, targeted preventive chemotherapy is highly recommended for all individuals with persistent M. tuberculosis-specific immune responses undergoing TNF antagonist therapy as it significantly reduces the risk of progression to TB.
This TBNET consensus statement summarises current knowledge and expert opinions and provides evidence-based recommendations to reduce the TB risk among candidates for TNF antagonist therapy.

Item Type:Article
ID Code:7952
Status:Published
Refereed:Yes
Uncontrolled Keywords:Interferon-c release assay, tuberculin skin test, tuberculosis, tumour necrosis factor
Subjects:Area 06 - Scienze mediche > MED/01 Statistica medica
Divisions:001 Università di Sassari > 01 Dipartimenti > Scienze biomediche
Publisher:European Respiratory Society
eISSN:1399-3003
Deposited On:14 Sep 2012 13:33

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