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Tuberculosis and viral hepatitis infection in Eastern Europe, Asia, and Latin America: impact of tumor necrosis factor-α inhibitors in clinical practice

Authors Chen YH, Carvalho HMS, Kalyoncu U, Llamado LJQ, Solano G, Pedersen R, Lukina G, Lichauco JJ, Vasilescu RS

Received 8 August 2017

Accepted for publication 18 November 2017

Published 12 January 2018 Volume 2018:12 Pages 1—9

DOI https://doi.org/10.2147/BTT.S148606

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Doris Benbrook


Yi-Hsing Chen,1 Hellen MDS de Carvalho,2 Umut Kalyoncu,3 Lyndon John Q Llamado,4 Gaston Solano,5 Ron Pedersen,6 Galina Lukina,7 Juan J Lichauco,8 Radu S Vasilescu9

1Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung City, Taiwan; 2Unidade de Reumatologia, Hospital de Base do Distrito Federal, Brasilia, Brazil; 3Department of Internal Medicine, Faculty of Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey; 4Pfizer, Makati City, Philippines; 5Pfizer, San Jose, Costa Rica; 6Pfizer, Collegeville, PA, USA; 7Moscow Clinical Scientific Center, Moscow, Russia; 8Section of Rheumatology, Department of Medicine, St. Luke’s Medical Center, Quezon City, Manila, Philippines; 9Pfizer, Brussels, Belgium

Abstract: Tumor necrosis factor-α (TNF-α) inhibitors are increasingly becoming the standard of care for treating a number of inflammatory diseases. However, treatment with TNF-α inhibitors carries an inherent risk of compromising the immune system, resulting in an increased susceptibility to infections and malignancies. This increased risk of infection is of particular concern in Asia, Eastern Europe, and Latin America where tuberculosis (TB) and viral hepatitis are endemic. In this brief review, we examine the literature and review the impact of TNF-α inhibitors on the incidence and the reactivation of latent disease with respect to TB, hepatitis C infection, and hepatitis B infection. Our findings show that TNF-α inhibitors are generally safe, if used with caution. Patients should be screened prior to the initiation of TNF-α inhibitor treatment and given prophylactic treatment if needed. In addition, patients should be monitored during treatment with TNF-α inhibitors and after treatment has stopped to ensure that infections, if detected, are treated promptly and effectively. Our analysis is consistent with other reports and guidelines.

Keywords: tuberculosis, hepatitis C, hepatitis B, tumor necrosis factor inhibitors, reactivation, risk

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