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Previous Volume 345:1098-1104 October 11, 2001 Number 15 Next

Tuberculosis Associated with Infliximab, a Tumor Necrosis Factor –Neutralizing Agent

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ABSTRACT

Background Infliximab is a humanized antibody against tumor necrosis factor (TNF-) that is used in the treatment of Crohn's disease and rheumatoid arthritis. Approximately 147,000 patients throughout the world have received infliximab. Excess TNF- in association with tuberculosis may cause weight loss and night sweats, yet in animal models it has a protective role in the host response to tuberculosis. There is no direct evidence of a protective role of TNF- in patients with tuberculosis.

Methods We analyzed all reports of tuberculosis after infliximab therapy that had been received as of May 29, 2001, through the MedWatch spontaneous reporting system of the Food and Drug Administration.

Results There were 70 reported cases of tuberculosis after treatment with infliximab for a median of 12 weeks. In 48 patients, tuberculosis developed after three or fewer infusions. Forty of the patients had extrapulmonary disease (17 had disseminated disease, 11 lymph-node disease, 4 peritoneal disease, 2 pleural disease, and 1 each meningeal, enteric, paravertebral, bone, genital, and bladder disease). The diagnosis was confirmed by a biopsy in 33 patients. Of the 70 reports, 64 were from countries with a low incidence of tuberculosis. The reported frequency of tuberculosis in association with infliximab therapy was much higher than the reported frequency of other opportunistic infections associated with this drug. In addition, the rate of reported cases of tuberculosis among patients treated with infliximab was higher than the available background rates.

Conclusions Active tuberculosis may develop soon after the initiation of treatment with infliximab. Before prescribing the drug, physicians should screen patients for latent tuberculosis infection or disease.

Source Information

From the Pulmonary Center, Department of Medicine (J. Keane, E.M.-L.), and the Pathology Department (J. Kasznica), Boston University School of Medicine, Boston; and the Center for Biologics Evaluation and Research, Office of Biostatistics and Epidemiology, Division of Epidemiology (S.G., R.P.W., M.M.B.), and Office of Therapeutics Research and Review (W.D.S., J.N.S.), Food and Drug Administration, Rockville, Md.

Address reprint requests to Dr. Keane at the Boston University School of Medicine, Pulmonary Ctr., 80 E. Concord St., R-304, Boston, MA 02118, or at jkeane{at}lung.bumc.bu.edu.

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