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Vol. 4. Núm. S2.
Monográfico: Infección y patologías microcristalinas
Páginas 18-23 (Octubre 2008)
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Vol. 4. Núm. S2.
Monográfico: Infección y patologías microcristalinas
Páginas 18-23 (Octubre 2008)
Infección y patologías microcristalinas
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Infecciones en pacientes con artritis reumatoide en tratamiento con fármacos anti-TNFα
Infections in Patients With Rheumatoid Arthritis Undergoing Anti-TNFα Drug Therapy
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Alberto Alonso Ruiz
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alonsoru@teleline.es

Correspondencia: Dr. A. Alonso Ruiz. Servicio de Reumatología. Hospital de Cruces. 48903 Baracaldo. Vizcaya. España.
Servicio de Reumatología. Hospital de Cruces. Baracaldo. Vizcaya. España
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Las infecciones son más frecuentes en los pacientes afectos de artritis reumatoide (AR). La capacidad de los fármacos contra el factor de necrosis tumoral (TNF) (infliximab, etanercept y adalimumab) para aumentar el riesgo de infecciones ha sido motivo de discusión durante los últimos años. Sólo en dos de los ensayos clínicos que han permitido la comercialización del infliximab y del adalimumab, se observó una mayor incidencia de infecciones graves. No se observó mayor incidencia de tuberculosis (TB) en los ensayos. Sin embargo, más tarde se han publicado estudios no controlados que muestran mayor incidencia de infecciones y de TB en pacientes con AR que reciben anti-TNFα. La discordancia entre los ensayos clínicos iniciales y los estudios no controlados posteriores ha sido el motivo de la realización de metaanálisis que estudian la frecuencia de infecciones en pacientes con AR que reciben fármacos anti-TNFα. Los tres metaanálisis publicados muestran un incremento del riesgo de infecciones en los pacientes con AR en tratamiento con infliximab y con adalimumab, especialmente cuando se administran dosis altas. El riesgo no parece estar aumentado con etanercept, probablemente debido a que no se han utilizado dosis superiores a las recomendadas en los ensayos analizados. El aumento en el riesgo de infecciones no fue detectado en los ensayos clínicos, pero el metaanálisis aumenta la potencia estadística y permite demostrar el incremento del riesgo de infecciones. Existe una relación causal entre la administración de fármacos anti-TNFα y el desarrollo de infecciones que cumple todos los criterios de causalidad.

Palabras clave:
Artritis reumatoide
Anti-TNFα
Infección

Infections are more frequent in patients with rheumatoid arthritis (RA). The capacity of the anti-TNF drugs (infliximab, etanercept, and adalimumab) to increase the risk of infections has been a motive of discussion during the past years. Only in two of the trials that have allowed the marketing of the infliximab and adalimumab more serious infections were observed. TB was not observed in the trials. Nevertheless, later they have been published not controlled studies that show infections and TB in patients with RA that receive anti-TNFα drugs. The disagreement between the trials and the not controlled studies has been the motive of the accomplishment of metaanalysis which study the frequency of infections in patients with RA that receive anti-TNFα drugs. The three metaanalysis published show an increase of the risk of infections in patients with AR in treatment with infliximab and with adalimumab, specially when they administer high doses. This risk does not seem to increase with etanercept, probably due to the fact that doses superior to the recommended ones have not been used in the analyzed trials. Increased risk of infections was not detected in the trials, but the metaanalysis increases the statistical power and allow demonstrating increased risk of infections. A causal relation exists between the administration of anti-TNFα and the development of infections, fulfilling all the criteria of causality.

Key words:
Rheumatoid arthritis
Anti-TNFα
Infection
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Esta revisión ha sido presentada en el I Simposio de infección y patologías microcristalinas, de la Sociedad Española de Reumatología (SER) (Cádiz, 8 de marzo de 2008).

Copyright © 2008. Elsevier España S.L. Barcelona
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