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drug adverse effects of TNF-alpha inhibitors

Adverse effects: 1) increased risk of soft tissue & skin infection 2) increased risk of intracellular baterial infection a) tuberculosis b) Listeria ? c) Salmonella ? d) Legionella ? 3) pulmonary & disseminated histoplasmosis, coccidioidomycosis, blastomycosis & other opportunistic infections are not consistently recognized in patients taking TNF-alpha blockers; this has resulted in delays in appropriate treatment, & death; empiric antifungal treatment indicated for suspected disseminated mycosis in patients taking TNF-alpha blocker 4) increased risk of lymphoma & other cancers associated with use in children & adolescents [3] 5) increased risk of melanoma in patients with rheumatoid arthritis (RR=1.5) [5] 6) TNF inhibitors do not increase risk of cancer recurrence in cancer survivors [6] 7) drug-induced lupus [4]

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DRUGS: tumor necrosis factor inhibitor FORM: drug adverse effects tnf alpha antagonist

References

  1. Dixon WG et al, Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy. Arthritis Rheum 2006, 54:2368 PMID: 16868999 - Singh JA et al Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet. May 11, 2015 PMID: 25975452 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961704-9/abstract - Dixon WG. Rheumatoid arthritis: Biological drugs and risk of infection. Lancet 2015 May 11 PMID: 25975453 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961907-3/abstract
  2. FDA MedWatch http://www.fda.gov/medwatch/safety/2008/safety08.htm#TNF2
  3. FDA MedWatch Tumor Necrosis Factor (TNF) Blockers (marketed as Remicade, Enbrel, Humira, Cimzia, and Simponi) August 2009 http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm175843.htm
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
  5. Raaschou P et al. Rheumatoid arthritis, anti-tumour necrosis factor therapy, and risk of malignant melanoma: Nationwide population based prospective cohort study from Sweden. BMJ 2013 Apr 8; 346:f1939 PMID: 23568792
  6. Raaschou P, Soderling J, Turesson C, Askling J; ARTIS Study Group. Tumor necrosis factor inhibitors and cancer recurrence in Swedish patients with rheumatoid arthritis: A nationwide population-based cohort study. Ann Intern Med 2018 Sep 4; 169:291 PMID: 30105374 http://annals.org/aim/article-abstract/2697083/tumor-necrosis-factor-inhibitors-cancer-recurrence-swedish-patients-rheumatoid-arthritis