scholarly journals Lethal disseminated tuberculosis in patients under biological treatment – two clinical cases and a short review

2018 ◽  
Vol 46 (7) ◽  
pp. 2961-2969 ◽  
Author(s):  
Elena Dantes ◽  
Doina Ecaterina Tofolean ◽  
Ariadna Petronela Fildan ◽  
Liviu Craciun ◽  
Elena Dumea ◽  
...  
Keyword(s):  
Biological Treatment ◽  
Biological Therapy ◽  
Opportunistic Infections ◽  
Short Review ◽  
Rapid Progression ◽  
Disseminated Tuberculosis ◽  
Increased Risk ◽  
Tnf Α ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Tumour necrosis factor (TNF)-α inhibitors are highly used in Romania for the treatment of autoimmune disorders, such as rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases, and ankylosing spondylitis. Biological therapy using TNF-α inhibitors is very effective but is associated with an increased risk of opportunistic infections, including active tuberculosis. Here, two cases are presented of patients with RA and psoriasis under biological therapy who developed very aggressive forms of disseminated tuberculosis, with a rapid progression to death. The authors conclude that patients undergoing biological therapy require thorough evaluation prior to initiating treatment, followed by continuous and rigorous monitoring by a multidisciplinary team during biological treatment, particularly in countries with a high incidence of tuberculosis.

scholarly journals Tuberculosis in patient with psoriasis receiving biologic therapy – case report

2020 ◽  
Author(s):  
Beata Wańczyk-Dręczewska ◽  
Agnieszka O wczarczyk-Saczonek ◽  
Waldemar Placek
Keyword(s):  
Biological Treatment ◽  
Biological Therapy ◽  
Malignant Tumors ◽  
Inhibitor Therapy ◽  
Interleukin 17 ◽  
Dermatology Clinic ◽  
Increased Risk ◽  
Tnf Α ◽  
Adalimumab Therapy ◽  
Factor Α

Introduction: The introduction of biological therapy has revolutionized the treatment of psoriasis. Due to its immunosuppressive effect, the following side effects might occur: injection-site reactions, exacerbation of autoimmune diseases, increased risk of malignant tumors and infections, including tuberculosis (TB). Aim: The aim of this report is to present a case of a patient who developed TB during tumornecrosis factor α (TNF-α) inhibitor therapy. Case study: A 52-year-old man was admitted to the Dermatology Clinic for re-qualification for biological treatment with adalimumab. The patient was treated with cyclosporin A and lefludomide combined with methotrexate with no effect and the adalimumab therapy was initiated with complete remission of psoriatic lesions. The patient was suspended in the drug program because of TB. TNF-α inhibitor therapy was resumed after antimycobacterial treatment, during which lymphadenopathy was observed and serous TB was confirmed. Three months after the treatment, the patient was rehospitalized because of suspicion of TB relapse. It was decided to requalify the patient for biological therapy after completion of antimycobacterial treatment. Due to the high risk of TB recurrence, switch to the interleukin-17 inhibitor was decided. Results and discussion: The proper qualification and thorough testing before biological treatment ensures patients’ safety and satisfactory therapeutic effect. It should be remembered that during longterm therapy with TNF antagonists, both reactivation of latent TB as well as new infection are serious problems. Therefore, regular tests should be performed, especially in countries with high prevalence of this disease. Conclusions: In patients who develop TB, particularly recurrent, switching to a drug with a different mechanism should be considered.

Biologic-Induced Infections in Inflammatory Bowel Disease: The TNF-α Antagonists

2018 ◽  
Vol 52 (6) ◽  
pp. 571-579 ◽  
Author(s):  
Sean M. McConachie ◽  
Sheila M. Wilhelm ◽  
Ashish Bhargava ◽  
Pramodini B. Kale-Pradhan
Keyword(s):  
Risk Factors ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Opportunistic Infections ◽  
Case Series ◽  
Infectious Risk ◽  
Increased Risk ◽  
Tnf Α ◽  
Inflammatory Bowel ◽  
Meta Analyses

Objective: To review the mechanism and association of infectious risk among the tumor-necrosis factor α (TNF-α) antagonists used in inflammatory bowel disease. Data Sources: A PubMed literature search was performed using the following search terms: infliximab, adalimumab, certolizumab, golimumab, inflammatory bowel disease, crohn’s, ulcerative colitis, adverse effects, adverse events, safety, and infection. Study Selection and Data Extraction: Meta-analyses and cohort studies with outcomes pertaining to quantitative infectious risk were reviewed. Case reports and case series describing association between TNF-α inhibitors and infection were also reviewed. Data Synthesis: A total of 7 recent meta-analyses of randomized trials demonstrate inconclusive association of infection with TNF-α antagonists. Registry data suggest that medications carry an independent risk of opportunistic infections. Risk factors for infection include older age, malnutrition, diabetes, and possibly combination therapy. Reported infections vary widely but include intracellular and granulomatous bacteria, viruses, and fungi. Conclusion: TNF-α antagonists are associated with an increased risk of opportunistic infection, although this risk has not been demonstrated conclusively in randomized controlled trials. Knowledge of concomitant risk factors, mechanism of infectious risk, and available treatment options can improve patient care in the clinical setting.

scholarly journals P359 Influence of the nature of immunosuppressive therapy in patients with inflammatory bowel diseases on the level of immunoglobulins G after a Coronavirus Infection

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S379-S379
Author(s):  
O Knyazev ◽  
A Kagramanova ◽  
A Lishchinskaya ◽  
K Noskova ◽  
M Chernova ◽  
...  
Keyword(s):  
Genetically Engineered ◽  
Janus Kinase ◽  
Average Level ◽  
International Studies ◽  
Increased Risk ◽  
Tnf Α ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Difference ◽  
Group 2

Abstract Background Currently, there are differences in the results of international studies and treatment outcomes in patients with inflammatory bowel disease (IBD) and COVID-19. Further research is needed to help answer the questions: do IBD patients have an increased risk of contracting SARS-CoV-2? Do IBD patients have more severe COVID-19 outcomes? Does IBD therapy increase the risk of infection? Do any IBD treatments protect against COVID-19? Objective To study the effect of immunosuppressors, genetically engineered biologics, and janus kinase blockers on the level of SARS-CoV-2 class G immunoglobulins in IBD patients who underwent COVID-19. . Methods The level of SARS-CoV-2 class G immunoglobulins was analyzed in 66 patients with IBD after COVID-19 infection. Male 28 (42.4%) of women 38 (57.6 per cent). The median age was 39±4.2 years. The duration of the anamnesis ranged from 1 to 8 years (Iu 4 years). The patients were divided into two groups, depending on the therapy performed: Group 1 (n=31) received long-term (more than 1 year) immunosuppressants (azathioprine/6-mercaptopurine/tofacitinib), group 2 (n=35) received anti-TNF-α therapy. The level of SARS-CoV-2 class G immunoglobulins was determined by the immunochemiluminescence method. Results After 4-6 weeks later, after a twice negative smear of PCR from the nose and oropharynx for SARS-CoV-2, in patients (n=31) receiving anti-relapse therapy with systemic IBD (azathioprine/6-mercaptopurine) and selective (tofacitinib) immunosuppressants, the average level of Ig G was 44.1±9.8 U/l. Among patients with IBD receiving anti-TNF-a drugs (n=35), the average level of class G immunoglobulins was 133.6±14.4 U/l. The difference was statistically significant (p=0.000003). Conclusion The level of class G immunoglobulins 3-4 weeks after the COVID-19 infection was significantly higher in IBD patients who received anti-TNF-α drugs.

scholarly journals Vaccines in Children with Inflammatory Bowel Disease: Brief Review

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 487
Author(s):  
Susanna Esposito ◽  
Giulia Antoniol ◽  
Marialuisa Labate ◽  
Lucrezia Passadore ◽  
Patrizia Alvisi ◽  
...  
Keyword(s):  
Immune System ◽  
Biological Therapy ◽  
Vaccine Preventable Diseases ◽  
Immune System Function ◽  
Increased Risk ◽  
Function Impairment ◽  
Bowel Diseases ◽  
Strict Compliance ◽  
Inflammatory Bowel ◽  
Immunomodulating Drugs

Incidence of inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis (UC), is increasing worldwide. Children with IBDs have a dysfunctional immune system and they are frequently treated with immunomodulating drugs and biological therapy, which significantly impair immune system functions and lead to an increased risk of infections. Vaccines are essential to prevent at least part of these infections and this explains why strict compliance to the immunization guidelines specifically prepared for IBD patients is strongly recommended. However, several factors might lead to insufficient immunization. In this paper, present knowledge on the use of vaccines in children with IBDs is discussed. Literature review showed that despite a lack of detailed quantification of the risk of infections in children with IBDs, these children might have infections more frequently than age-matched healthy subjects, and at least in some cases, these infections might be even more severe. Fortunately, most of these infections could be prevented when recommended schedules of immunization are carefully followed. Vaccines given to children with IBDs generally have adequate immunogenicity and safety. Attention must be paid to live attenuated vaccines that can be administered only to children without or with mild immune system function impairment. Vaccination of their caregivers is also recommended. Unfortunately, compliance to these recommendations is generally low and multidisciplinary educational programs to improve vaccination coverage must be planned, in order to protect children with IBD from vaccine-preventable diseases.

scholarly journals Drug Targeting of Inflammatory Bowel Diseases by Biomolecules

Nanomaterials ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 2035
Author(s):  
Joana Costa Antunes ◽  
Catarina Leal Seabra ◽  
Joana Margarida Domingues ◽  
Marta Oliveira Teixeira ◽  
Cláudia Nunes ◽  
...  
Keyword(s):  
Opportunistic Infections ◽  
Inflammatory Diseases ◽  
Treatment Options ◽  
Stimuli Responsive ◽  
Triggered Release ◽  
Healthy State ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory State ◽  
Inflammatory Bowel

Inflammatory bowel disease (IBD) is a group of disabling, destructive and incurable immune-mediated inflammatory diseases comprising Crohn’s disease (CD) and ulcerative colitis (UC), disorders that are highly prevalent worldwide and demand a large investment in healthcare. A persistent inflammatory state enables the dysfunction and destruction of healthy tissue, hindering the initiation and endurance of wound healing. Current treatments are ineffective at counteracting disease progression. Further, increased risk of serious side effects, other comorbidities and/or opportunistic infections highlight the need for effective treatment options. Gut microbiota, the key to preserving a healthy state, may, alternatively, increase a patient’s susceptibility to IBD onset and development given a relevant bacterial dysbiosis. Hence, the main goal of this review is to showcase the main conventional and emerging therapies for IBD, including microbiota-inspired untargeted and targeted approaches (such as phage therapy) to infection control. Special recognition is given to existing targeted strategies with biologics (via monoclonal antibodies, small molecules and nucleic acids) and stimuli-responsive (pH-, enzyme- and reactive oxygen species-triggered release), polymer-based nanomedicine that is specifically directed towards the regulation of inflammation overload (with some nanosystems additionally functionalized with carbohydrates or peptides directed towards M1-macrophages). The overall goal is to restore gut balance and decrease IBD’s societal impact.

Anti-adhesion Molecules in IBD: Does Gut Selectivity Really Make the Difference?

2019 ◽  
Vol 25 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Ferdinando D'Amico ◽  
Giulia Roda ◽  
Laurent Peyrin-Biroulet ◽  
Silvio Danese
Keyword(s):  
Adhesion Molecules ◽  
Biological Treatment ◽  
Current Data ◽  
New Drugs ◽  
Inflammatory Infiltration ◽  
New Class ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Difference ◽  
Necrosis Factor

Inflammatory Bowel Disease is lifetime chronic progressive inflammatory disease. A considerable portion of patients, do not respond or lose response or experience side effect to “traditional” biological treatment such as anti-tumor necrosis factor (TNF)-α agents. The concept that the blockade of T cell traffic to the gut controls inflammation has stimulated the development of new drugs which selectively targets molecules involved in controlling cell homing to the intestine. The result is the reduction of the chronic inflammatory infiltration in the gut. In this regard, anti-adhesion molecules represent a new class of drugs for patients who don’t respond or lose response to traditional therapy. Moreover, some of these molecules such as vedolizumab, offer the advantage to target the delivery of a drug to the gut (gut selectivity) which could increase clinical efficacy and limit potential adverse events. In this article, we will give an overview of the current data on anti-adhesion molecules in Inflammatory Bowel Diseases.

Thrombosis in IBD in the Era of JAK Inhibition

2020 ◽  
Vol 22 (1) ◽  
pp. 126-136
Author(s):  
Virginia Solitano ◽  
Gionata Fiorino ◽  
Ferdinando D’Amico ◽  
Laurent Peyrin-Biroulet ◽  
Silvio Danese
Keyword(s):  
Small Molecules ◽  
Arterial Thrombosis ◽  
Protective Role ◽  
Jak Inhibitors ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Thrombotic Complications ◽  
Inflammatory Bowel ◽  
Inflammatory Effect

: Patients with inflammatory bowel diseases (IBD) have an increased risk of thrombosis. The interaction between inflammation and coagulation has been extensively studied. It is well-known that some drugs can influence the haemostatic system, but several concerns on the association between therapies and increased risk of thrombosis remain open. While biologics seem to have a protective role against thrombosis via their anti-inflammatory effect, some concerns about an increased risk of thrombosis with JAK inhibitors have been raised. We conducted a literature review to assess the association between biologics/small molecules and venous/arterial thrombotic complications. An increased risk of venous and arterial thrombosis was found in patients treated with corticosteroids, whereas anti-TNF were considered protective agents. No thromboembolic adverse event was reported with vedolizumab and ustekinumab. In addition, thromboembolic events rarely occurred in patients with ulcerative colitis (UC) after therapy with tofacitinib. The overall risk of both venous and arterial thrombosis was not increased based on the available evidence. Finally, in the era of JAK inhibitors, treatment should be individualized by evaluating the pre-existing potential thrombotic risk balanced with the intrinsic risk of the medication used.

scholarly journals The Role of Portal Vein Thrombosis in the Clinical Course of Inflammatory Bowel Diseases: Report on Three Cases and Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Emanuele Sinagra ◽  
Emma Aragona ◽  
Claudia Romano ◽  
Simonetta Maisano ◽  
Ambrogio Orlando ◽  
...  
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Inflammatory Bowel Diseases ◽  
Vascular Complications ◽  
Hepatic Abscess ◽  
Vein Thrombosis ◽  
Increased Risk ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Thromboembolism Events

Inflammatory bowel diseases are associated with an increased risk of vascular complications. The most important are arterial and venous thromboembolisms, which are considered as specific extraintestinal manifestations of inflammatory bowel diseases. Among venous thromboembolism events, portal vein thrombosis has been described in inflammatory bowel diseases. We report three cases of portal vein thrombosis occurring in patients with active inflammatory bowel disease. In two of them, hepatic abscess was present. Furthermore, we performed a systematic review based on the clinical literature published on this topic.

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