ABSTRACT
Introduction: Registries of spondyloarthritis (SpA) patients' follow-up provided evidence that tumor necrosis factor inhibitors (TNFi) increase the incidence of active tuberculosis infection (TB). However, most of these registries are from low burden TB areas. Few studies evaluated the safety of biologic agents in TB endemic areas. This study compares the TB incidence rate (TB IR) in anti-TNF-naïve and anti-TNF-experienced subjects with SpA in a high TB incidence setting.Methods: In this retrospective cohort study, medical records from patients attending a SpA clinic during 13 years (2004 to 2016) in a university hospital were reviewed. The TB IR was calculated and expressed as number of events per 105 patients/year; the incidence rate ratio (IRR) associated with the use of TNFi was calculated.Results: A total of 277 patients, 173 anti-TNF-naïve and 104 anti-TNF-experienced subjects, were evaluated; 35.7% (N = 35) of patients who were prescribed an anti-TNF drug were diagnosed with latent tuberculosis infection (LTBI). Total follow-up time (person-years) was 1667.8 for anti-TNF-naïve and 394.9 for anti-TNF-experienced patients. TB IR (95% CI) was 299.8 (37.4-562.2) for anti-TNF naïve and 1012.9 (25.3-2000.5) for anti-TNF experienced subjects. The IRR associated with the use of TNFi was 10.4 (2.3- 47.9).Conclusions: In this high TB incidence setting, SpA patients exposed to anti-TNF therapy had a higher incidence of TB compared to anti-TNF-naïve subjects, although the TB incidence in the control group was significant.(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Tuberculosis/chemically induced , Tuberculosis/epidemiology , Biological Products/adverse effects , Antirheumatic Agents/adverse effects , Spondylarthritis/drug therapy , Tumor Necrosis Factor Inhibitors/adverse effects , Spondylitis, Ankylosing/drug therapy , Biological Products/therapeutic use , Arthritis, Psoriatic/drug therapy , Incidence , Retrospective Studies , Follow-Up Studies , Antirheumatic Agents/therapeutic use , Endemic Diseases , Latent Tuberculosis/drug therapy , Tumor Necrosis Factor Inhibitors/therapeutic useABSTRACT
O Syzygium cumini, também conhecido como Jamboläo é amplamente utilizado na medicina popular para o tratamento da diabetes melito. Este estudo verificou a eficiência do extrato da casca de Syzygium cumini sobre os níveis glicêmicos e estresse oxidativo de ratos normais e diabéticos induzidos por aloxano. Os animais foram divididos em grupo controle (C), controle tratado (CT), diabético controle (DC) e diabético tratado (DT). A administraçäo oral do extrato aquoso da casca de Jamboläo, na dose de 1g/kg de peso vivo, por um período de trinta dias, näo resultou em uma reduçäo significativa na glicemia e nos níveis de hemoglobina glicosilada. Neste estudo, o tratamento com o extrato demonstrou um aumento dos níveis de substâncias reativas ao ácido tiobarbitúrico (TBA-RS) no plasma dos ratos do grupo DT (P<0,05), comparado com o C. A atividade da catalase nos rins dos ratos do grupo DC diminuiu significativamente (P<0,01) e no fígado houve uma elevaçäo significativa dessa enzima no grupo DC (P<0,01). Estes resultados indicam que o extrato da casca do Jamboläo näo possui efeito hipoglicemiante em ratos diabéticos induzidos pelo aloxano. O efeito antioxidante desta planta näo foi suficiente para diminuir significativamente a produçäo de TBA-RS. A diminuiçäo da atividade da catalase nos rins pode ser devida à exaustäo ou inibiçäo desta enzima e seu aumento, no fígado, devido ao estresse oxidativo, ocasionado pelo estado diabético