Anti-tumour necrosis factor-alpha (anti-TNF) agents represented treatment advances in a number of rheumatologic diseases. However, adverse effects of anti-TNF agents have been identified through both clinical trials and post-marketing surveillance, especially an increased risk of serious infections. This study firstly described the infectious profiles of anti-TNF agents in a Thai population.
We retrospectively reviewed all infectious incidences from 100 consecutive medical records of patients who were treated with either etanercept or infliximab for any rheumatologic and non-rheumatologic conditions.
Indications for anti TNF-alpha agents were mainly rheumatoid arthritis (46%) and spondyloarthropathy (SpA) (41%). Seventy-seven patients were treated with etanercept and 23 with infliximab. For those whose initial treatment was etanercept, there were two events of suspected active pulmonary tuberculosis (TB) and suspected hepatitis-B virus (HBV) reactivation. Two out of 23 patients (8.7%) who were firstly treated with infliximab had herpes zoster skin infection. Incidence of overall infection before anti-TNF treatment were significantly higher in patient who started with etanercept (0.065 vs. 0.019 cases per person-years in etanercept and infliximab respectively, P < 0.0001). Incidence of overall infection post-anti-TNF treatment were 0.122 and 0.201 cases per person-years in patients who started with etanercept and infliximab with no significant difference (P > 0.05). The overall infection rates were significantly increased after infliximab treatment (P < 0.0001).
Even thought there were two new events of TB and HBV reactivation after etanercept treatment, incidence of overall infection seemed to be increased after infliximab treatment. The infectious screening and monitoring with high index of suspicion as well as the pre-emptive treatment are still important whenever either etanercept or infliximab is started.