PMID- 26677996 OWN - NLM STAT- MEDLINE DCOM- 20161213 LR - 20200205 IS - 1778-7254 (Electronic) IS - 1297-319X (Linking) VI - 83 IP - 2 DP - 2016 Mar TI - Paradoxical anti-TNF-associated TB worsening: Frequency and factors associated with IRIS. PG - 173-8 LID - S1297-319X(15)00255-9 [pii] LID - 10.1016/j.jbspin.2015.04.022 [doi] AB - OBJECTIVES: Paradoxical tuberculosis (TB) worsening, an example of the immune reconstitution inflammatory syndrome (IRIS), is an increasing phenomenon now described in several settings, including anti-tumor necrosis factor (TNF) discontinuation during biotherapy-induced TB. To better recognize it, we analyzed the frequency and factors associated with anti-TNF-induced TB-IRIS. METHODS: Case-control study on anti-TNF-associated TB patients. IRIS cases, defined with the following consensus criteria, were matched to two controls (anti-TNF-associated TB without IRIS). IRIS frequency was based on the French RATIO registry. Conditional logistic-regression identified IRIS risk factors. RESULTS: Fourteen patients developed anti-TNF-associated TB-IRIS within medians of 45 [IQR 22-131] days after starting anti-TB therapy and 110 [IQR 63-164] days after the last anti-TNF infusion. Each case was matched to two controls by year of TB diagnosis. IRIS-associated factors were (odds ratio [95% CI]): disseminated TB (11.4 [1.4-92.2], P=0.03), history of Mycobacterium tuberculosis exposure (12.7 [1.6-103.0], P=0.02) and steroid use at the time of TB diagnosis (4.6 [1.2-17.2], P=0.02). The RATIO registry IRIS frequency was 7%. CONCLUSION: After stopping biotherapy, paradoxical anti-TNF-associated TB worsening occurred most often in patients with disseminated TB. Although diagnosis remains difficult, physicians must be aware of IRIS because prolonged anti-TB treatment is not needed but, paradoxically, immunosuppressant reintroduction may be. CI - Copyright (c) 2015 Societe francaise de rhumatologie. Published by Elsevier SAS. All rights reserved. FAU - Rivoisy, Claire AU - Rivoisy C AD - Service de maladies infectieuses, universite Pierre-et-Marie-Curie, hopital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France. Electronic address: claire.rivoisy@sat.aphp.fr. FAU - Tubach, Florence AU - Tubach F AD - Inserm, ECEVE, UMR 1123, universite Paris Diderot, Sorbonne Paris Cite, 75010 Paris, France; Departement d'epidemiologie et de recherche clinique, hopital Bichat, AP-HP, 75018 Paris, France. FAU - Roy, Carine AU - Roy C AD - Inserm, ECEVE, UMR 1123, universite Paris Diderot, Sorbonne Paris Cite, 75010 Paris, France; Departement d'epidemiologie et de recherche clinique, hopital Bichat, AP-HP, 75018 Paris, France. FAU - Nicolas, Nathalie AU - Nicolas N AD - Inserm, CIC 1425-EC, departement d'epidemiologie et de recherche clinique, hopital Bichat, AP-HP, 75018 Paris, France. FAU - Mariette, Xavier AU - Mariette X AD - Inserm U1012, universite Paris-Sud, hopitaux universitaires Paris-Sud, AP-HP, Le Kremlin-Bicetre, France. FAU - Salmon, Dominique AU - Salmon D AD - Universite Paris Descartes, hopital Cochin, AP-HP, 75014 Paris, France. FAU - Lortholary, Olivier AU - Lortholary O AD - Centre d'infectiologie Necker-Pasteur, service des maladies infectieuses et tropicales, IHU Imagine, universite Paris Descartes, hopital universitaire Necker-Enfants Malades, AP-HP, 75015 Paris, France. FAU - Bourgarit, Anne AU - Bourgarit A AD - Service de medecine interne, universite Paris-Seine Saint-Denis, SMBH, hopital Jean-Verdier, AP-HP, 93140 Bondy, France; Inserm UMR-S 945, hopital Pitie-Salpetriere, 75013 Paris, France. CN - RATIO Group LA - eng PT - Journal Article DEP - 20151208 PL - France TA - Joint Bone Spine JT - Joint bone spine JID - 100938016 RN - 0 (Immunosuppressive Agents) RN - 0 (Tumor Necrosis Factor-alpha) SB - IM MH - Adult MH - Aged MH - Arthritis/*drug therapy MH - Biological Therapy/adverse effects MH - Case-Control Studies MH - Disease Progression MH - Female MH - Humans MH - Immune Reconstitution Inflammatory Syndrome/*chemically induced/etiology MH - Immunosuppressive Agents/*adverse effects/therapeutic use MH - Latent Tuberculosis/diagnosis MH - Male MH - Middle Aged MH - Registries MH - Retrospective Studies MH - Risk Factors MH - Skin Diseases, Vascular/drug therapy MH - Tuberculosis/*chemically induced/etiology MH - Tumor Necrosis Factor-alpha/*antagonists & inhibitors OTO - NOTNLM OT - IRIS OT - TNF-blockers OT - Tuberculosis FIR - Bagheri, H IR - Bagheri H FIR - Blandin, B IR - Blandin B FIR - Breban, M IR - Breban M FIR - Bretagne, S IR - Bretagne S FIR - Castot, A IR - Castot A FIR - Chichmanian, R-M IR - Chichmanian RM FIR - Chosidow, O IR - Chosidow O FIR - Dautzenberg, B IR - Dautzenberg B FIR - Dellamonica, P IR - Dellamonica P FIR - Dufeu-Demazes, N IR - Dufeu-Demazes N FIR - Emilie, D IR - Emilie D FIR - Gillet, C IR - Gillet C FIR - Hugot, J-P IR - Hugot JP FIR - Kreft-Jais, C IR - Kreft-Jais C FIR - Lemann, M IR - Lemann M FIR - Leport, C IR - Leport C FIR - Lortholary, O IR - Lortholary O FIR - Mariette, X IR - Mariette X FIR - Michelet, C IR - Michelet C FIR - Montastruc, J-L IR - Montastruc JL FIR - Nicolas, N IR - Nicolas N FIR - Prieur, A-M IR - Prieur AM FIR - Ravaud, P IR - Ravaud P FIR - Roux, C IR - Roux C FIR - Salmon, D IR - Salmon D FIR - Tubach, F IR - Tubach F FIR - Vittecoq, D IR - Vittecoq D EDAT- 2015/12/19 06:00 MHDA- 2016/12/15 06:00 CRDT- 2015/12/19 06:00 PHST- 2015/02/24 00:00 [received] PHST- 2015/04/20 00:00 [accepted] PHST- 2015/12/19 06:00 [entrez] PHST- 2015/12/19 06:00 [pubmed] PHST- 2016/12/15 06:00 [medline] AID - S1297-319X(15)00255-9 [pii] AID - 10.1016/j.jbspin.2015.04.022 [doi] PST - ppublish SO - Joint Bone Spine. 2016 Mar;83(2):173-8. doi: 10.1016/j.jbspin.2015.04.022. Epub 2015 Dec 8.