Infliximab

Brief Communication: Characteristics of Spontaneous Cases of Tuberculosis Associated with Infliximab Angela Raval, PharmD; Gita Akhavan-Toyserkani, PharmD, MBA; Allen Brinker, MD, MS; and Mark Avigan, MD, CM
20 November 2007 Volume 147 Issue 10 Pages 699-702
Background: A warning for tuberculosis was added to the approved labeling for infliximab in October 2001.
Objective: To describe adverse event reports of tuberculosis during infliximab therapy after labeling changes.
Design: Case series.
Setting: Spontaneous adverse event reports maintained in the Adverse Event Reporting System database in the United States.
Patients: 130 patients with infliximab-associated tuberculosis.
Measurements: Clinical and laboratory data.
Results: The U.S. Food and Drug Administration received 130 domestic, spontaneous reports of tuberculosis in patients treated with infliximab between 1 November 2001 and 30 May 2006, including 59 (45%) with extrapulmonary disease. The most commonly reported risk factors included concomitant immunosuppressant use (n = 89), history of latent or active tuberculosis (n = 33), and being born into or having spent extensive time in an area where tuberculosis is endemic (n = 25). In the subset of 67 cases with documented initiation of infliximab therapy after the drug labeling change, 34 patients with a negative tuberculin skin test result before initiation of infliximab therapy developed tuberculosis after receiving infliximab.
Limitation: Conclusions from spontaneous case reports may not be generalizable to the entire infliximab-receiving population.
Conclusion: Clinicians should be vigilant in screening and monitoring for tuberculosis in patients receiving infliximab