Is It Possible to Discontinue Tumor Necrosis Factor Antagonists after Psoriasis Remission?

Tumor necrosis factor (TNF) antagonists are highly effective treatments for psoriasis. These agents provide the opportunity to improve disease activity and achieve clinical remission. Despite its efficacy, long-term use of biologics is associated with high financial costs and possibly life-threatening adverse events. Recently, there has been an increasing interest in discontinuing TNF antagonists in patients with psoriasis who have achieved a positive clinical response. However, there is a paucity of data and clinical guidelines concerning the cessation TNF antagonists in psoriasis treatment. Several factors, including cost, subsequent treatment efficacy, relative risks, and tolerability, should be considered before the decision is made to discontinue TNF antagonists. Well-designed clinical trials are necessary to identify factors that may trigger disease exacerbation after medication discontinuation in order to recognize the potential disadvantages of discontinuing treatment in patients who are previously successfully managed on TNF antagonists.

A fatal case of tuberculous meningitis in a child with juvenile idiopathic arthritis: a diagnostic challenge

Abstract The prognosis of tuberculous meningitis, a rare form of extrapulmonary tuberculosis, depends on the stage of treatment initiation. We report a fatal case of tuberculous meningitis. The patient had received successive tumor necrosis factor (TNF) antagonists and abatacept to treat juvenile idiopathic arthritis, with negative results for polymerase chain reaction and acid-fast bacilli on smear, had normal cerebrospinal fluid (CSF) adenosine deaminase and glucose levels. Six weeks post-admission, the CSF culture demonstrated Mycobacterium tuberculosis. The altered immunological responses caused by anti-TNF treatment made the diagnosis challenging. Clinicians should bear this in mind and, if suspected, treatment should be initiated immediately.

Tuberculosis pleural asociada con adalimumab, en un paciente con artritis reumatoide / Pleural tuberculosis associated with adalimumab in a patient with rheumatoid arthritis

La tuberculosis constituye, en nuestro medio, una de las enfermedades infecciosas endémicas. Con el advenimiento de las nuevas terapias para el control de la artritis reumatoide,como los inhibidores del factor denecrosis tumoral, la incidencia de casos de reactivación ha aumentado notoriamente. Se presenta el caso de una mujer de 42 años de edad, con disnea, dolor torácico, tos, derrame pleural con líquido pleural tipo exudado linfocítico, con deaminasa de adenosina (ADA) de 55 U-L e identificación de granuloma en la biopsia pleural. Se revisa laliteratura y se hacen recomendaciones.

Tuberculosis (TB) represents one of the endemic infectious diseases in our population. The incidence of reactivate TB cases has grown notoriously with the onset of new therapeutic options for controlling rheumatoid arthritis (RA), such as tumor necrosis factor (TNF) inhibitors. The case of a 42 year old woman is highlighted. Her condition is characterized by shortness ofbreath, chest pain, cough, pleural effusion, linfocitic exudate pleural fluid, ADA 55 U-L and granuloma in pleural biopsy. A review of relevant literature and recommendations are presented.

Risk of tuberculosis in rheumatoid arthritis and ankylosing spondylitis patients treated with tumor necrosis factor antagonists / 中华风湿病学杂志

Objective To study the risk of tuberculosis (TB) infection in rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients before and after treated with tumor necrosis factor (TNF) antago- nists.Methods RA and AS patients treated with TNF antagonists infliximab and etanercept between 2003 and 2006 were followed up for the risk of TB infection.The protein purified derivative (PPD) test and chest anteroposterior and lateral view X-ray were done at screening for all these patients.Results Among 67 RA patients screened,1 was PPD positive.One patient developed right supraclavicular lymph node TB 4 months after study completion.Among 203 AS patients screened,27 patients were PPD positive,2 had calcified pul- monary TB foci and 2 had pulmonary TB.PPD positive rates and calcified TB foci or active TB found in RA and AS patients screened were significantly lower than national TB infection rates and prevalence (P＜0.01). Conclusion In this short-term clinical observation,increased risk of TB infection was not found after TNF antagonists treatment in RA and AS patients.However,it is necessary to screen patients for signs of TB infec- tion before TNF antagonists treatment.