[논문]Tumor Necrosis Factor-alpha 저해제가 결핵 발생에 미치는 영향

박현진; 최보윤; 손민지; 한나영; 김인화; 오정미

doi:10.24304/kjcp.2018.28.4.333

[국내논문] Tumor Necrosis Factor-alpha 저해제가 결핵 발생에 미치는 영향
Effects of Tumor Necrosis Factor-alpha Inhibitors on the Incidence of Tuberculosis 원문보기

한국임상약학회지 = Korean journal of clinical pharmacy, v.28 no.4, 2018년, pp.333 - 341

박현진 (서울대학교 약학대학, 종합약학연구소) , 최보윤 (서울대학교 약학대학, 종합약학연구소) , 손민지 (서울대학교 약학대학, 종합약학연구소) , 한나영 (서울대학교 약학대학, 종합약학연구소) , 김인화 (서울대학교 약학대학, 종합약학연구소) , 오정미 (서울대학교 약학대학, 종합약학연구소)

Abstract ▼ AI-Helper

Objective: Tumor necrosis factor-alpha (TNF-alpha) inhibitors are used as a treatment in various immune-mediated inflammatory diseases (IMIDs). Tuberculosis (TB) risk is reported in several meta-analyses in patients treated with TNF-alpha inhibitors. The purpose of this study is to collect, review, and evaluate the TB risk in TNF-alpha inhibitors according to IMIDs indications and between soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alpha inhibitors. Methods: A systematic literature search on systematic reviews and meta-analyses was performed in PubMed, MEDLINE, Cochrane library, and EMBASE. We identified meta-analyses that evaluated TB infection risk of TNF-alpha inhibitors in IMIDs patients. Results: Thirteen meta-analyses including 41 study results were included in this umbrella review. IMIDs patients treated with TNF-alpha inhibitors had an increased risk of TB than control group (placebo with or without standard therapy patients) (relative risk ratio (RR) 2.057, 95% confidence interval (CI) 1.697 to 2.495). Among them, RA patients with TNF-alpha inhibitors had a higher risk of TB than control group (RR 1.847, 95% CI 1.385 to 2.464), and non-RA patients with TNF-alpha inhibitors had an increased risk of TB (RR 2.236, 95% CI 1.284 to 3.894). In subgroup analysis on TB risk between soluble-receptor TNF-alpha inhibitor and monoclonal-antibody TNF-alpha inhibitors in RA patients, the analysis indicated that monoclonal-antibody TNF-alpha inhibitors had higher risk of TB than soluble-receptor TNF-alpha inhibitor (RR 2.880, 95% CI 1.730 to 4.792). Conclusion: This umbrella review confirms that the risk of TB is significantly increased in TNF-alpha inhibitor treated patients compared to control group.

주제어

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문제 정의

To our knowledge, this study is the first umbrella review conducted in evaluating risk of TB in TNF-alpha inhibitors treated patients. With increasing number of systematic reviews and meta-analyses on tuberculosis risk associated with TNFalpha inhibitor treatment, this study conducted a methodology, umbrella review, to integrate, manage, and provide a comprehensive evidence on this safety issue.

제안 방법

³⁵⁾ conducted an umbrella review on the safety issue of biological therapies in patients with ulcerative colitis and evaluated TB risk results as one of the safety measurements in the study. However, this study examined overall safety issues in biological agents including ADA, GOL, IFX, along with vedolizumab which is not a TNF-alpha inhibitor and reported insignificant results for TB risk in biologics group. Also, Bonovas et al.

대상 데이터

We searched a total of 748 articles in PubMed, MEDLINE, Cochrane, and EMBASE. After duplication exclusion, we screened titles, abstracts, and full texts for study exclusion which was narrowed down to 16 meta-analyses articles which met the inclusion criteria for this umbrella review.

후속연구

In addition, because we did not directly analyze the raw data for each included study, we could not directly compare TB infection risk between TNF-alpha inhibitors treated RA patients and non-RA patients. Since RA patients tend to use marginally higher induction dose of TNF-alpha inhibitors for treatment than nonRA patients^36-40), further research is needed to compare the TB risk between RA patients and non-RA patients.

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표제어: PCR

동의어: Packet Collision Rate

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용어 설명: PCR은 세균 특이성이 있는 primer를 이용하여 적은 수의 세균이 있을지라도 쉽게 검출할 수 있는 유용한 방법이며, 이를 이용하여 구강 내 치면세균막이나 타액에서 직접 세균을 검출할 수 있게 되었다[8].

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