Serious infections associated with anticytokine therapies in the rheumatic diseases.
Serious infections associated with anticytokine therapies in the rheumatic diseases.
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DOI：
10.1177/0885066604267854
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发表时间：
2004-11-01
影响因子：
3.1
通讯作者：
Bathon, Joan M
中科院分区：
文献类型：
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作者：
Giles, Jon T;Bathon, Joan M
近年来，靶向和中和巨噬细胞衍生的炎性细胞因子，特别是肿瘤坏死因子-α（TNF-α）的能力已经成为治疗类风湿性关节炎、克罗恩病和几种其他全身性炎性疾病的最重要进展之一。例如，在类风湿性关节炎中，这些生物制剂迅速减少关节炎症的体征和症状，并大大减缓关节损伤的进展。然而，美国食品和药物管理局批准这些药物后出现的数据提醒临床医生，使用这些药物治疗的患者发生机会性感染的可能性增加，特别是结核病。TNF抑制对更常见细菌病原体感染频率的影响尚不清楚。结核病和其他机会性感染的动物模型已经证明了TNF-α在控制和遏制细胞内病原体方面的重要性。本文综述了迄今为止在抗TNF-α治疗背景下报告的感染谱。此外，相关的动物数据说明潜在的机制作用，TNF-α在宿主感染的反应也进行了审查。
The ability to target and neutralize macrophage-derived inflammatory cytokines, particularly tumor necrosis factor-alpha (TNF-alpha), has emerged in recent years as one of the most important advances in the treatment of rheumatoid arthritis, Crohn's disease, and several other systemic inflammatory diseases. In rheumatoid arthritis, for example, these biological agents rapidly reduce signs and symptoms of joint inflammation and profoundly slow the progression of joint damage. However, data that have emerged following Food and Drug Administration approval of these agents have alerted clinicians to an increased likelihood of opportunistic infections in patients treated with these agents, particularly tuberculosis. The effect of TNF inhibition on the frequency of infection with more common bacterial pathogens is less clear. Animal models of tuberculosis and other opportunistic infections have demonstrated the importance of TNF-alpha in controlling and containing intracellular pathogens. The spectrum of infections reported to date in the setting of anti-TNF-alpha treatment is reviewed here. In addition, relevant animal data illustrating potential mechanistic roles for TNF-alpha in host responses to infection are also reviewed.