Preventing tuberculosis in children receiving anti-TNF treatment.
ABSTRACT Anti-tumor necrosis factor (TNF) treatment has been a breakthrough in the management of juvenile idiopathic arthritis (JIA). However, they are associated with a significant risk of tuberculosis. We evaluated JIA patients who received etanercept treatment from an eastern Mediterranean country with moderate tuberculosis frequency. JIA patients under anti-TNF treatment, etanercept, were enrolled to the study. Chest X-rays, Tuberculin Skin Test (TST), clinical histories, family screening, and physical examinations were reviewed retrospectively. If TST was above 10 mm in a patient with one Bacillus Calmette-Guerin, cultures and, if needed, thorax computerized tomography were obtained. These patients received 1-2 months of isoniazid (INH) treatment which was followed by an INH prophylaxis for a period of 9 months while etanercept treatment was started. All were re-evaluated within 3 months intervals. A total of 36 patients under etanercept treatment were enrolled to the study. Mean age of the patients was 14.00 years (range 4-22 years). Median duration of disease was 36.00 months (range 4-216 months). Median duration of etanercept therapy was 11.5 months (3-48 months) at final evaluation. Seven patients had an initial TST score above 10 mm. All received INH treatment as outlined above. They had normal examinations and X-rays during followup. With proper initial evaluation, anti-TNF treatment is safe even in countries where tuberculosis is moderately frequent. An initial 1-2 months of INH treatment followed by chemoprophylaxis for 9 months is suggested for children with a TST of >10 mm.
- SourceAvailable from: Katherine Anne B Marzan
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- "However, a positive tuberculin skin test does not preclude the use of anti-TNF agents, particularly if they are necessary to prevent disease progression. Completing at least the first month of a 9-month course of isoniazid therapy would be prudent, prior to initiating treatment with adalimumab.66,67 "
ABSTRACT: Treatment of children and adolescents with juvenile idiopathic arthritis and other pediatric rheumatic diseases has evolved. Where once there was only a limited arsenal of medications, with significant side effects and inadequate efficacy, today, with an increased understanding of the pathogenesis of these diseases, there is a wider variety of more targeted and effective treatments. TNF-α is a cytokine involved in a number of inflammatory pathways in pediatric rheumatic diseases. The emergence of biologic modifiers that target TNF-α has been pivotal in providing the ability to deliver early and aggressive treatment. Adalimumab, a recombinant monoclonal antibody to TNF-α, is an important therapeutic option, which affords children and adolescents with chronic illnesses an improved quality of life.Adolescent Health, Medicine and Therapeutics 06/2012; 3:85-93. DOI:10.2147/AHMT.S22607
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ABSTRACT: The author discusses the benefits of using structured programming, sequential function charts, and structured text as an alternative or supplement to the ladder logic traditionally used for programming of programmable controllers with regard to the pending IEC SC65A/B standard (soon to become IEC 1131). The aim is to identify the programmable controller applications where the methodologies can be applied and consider effective strategies for applying programmable controllers.< >Electrical Engineering Problems in the Rubber and Plastics Industries, 1992., IEEE Conference Record of 1992 Forty-Fourth Annual Conference of; 05/1992
Article: [Biological therapy in pediatrics].[Show abstract] [Hide abstract]
ABSTRACT: In the late 1980s, the murine monoclonal antibody muromonab was used in children undergoing organ transplantation. Since then, dozens of new molecules have been developed to modulate the immune response, block growth factors, or prevent infections on the basis of the antigen-antibody-specific response. In pediatrics, most biological therapies are used off-label, although they are effective and well tolerated and are used as first-line therapy in some severe genetic diseases. Biologicals allow specific targeting and can be engineered against any antigen. The safety of these treatments varies depending on the molecule and precise knowledge of side effects is essential for clinicians. The development of these promising agents requires clinical trials in children to validate their effectiveness and safety in the medium and long term.Archives de Pédiatrie 09/2010; 17(11):1573-82. · 0.41 Impact Factor