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Série de casos de tuberculose em doentes com doença inflamatória intestinal sob terapêutica anti-TNF-α num hospital distrital
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A implementação de fármacos anti-TNF-α, como Infliximab e Adalimumab, revolucionaram o tratamento das doenças inflamatórias intestinais (DII). Contudo, apresentam o potencial de provocar efeitos adversos, alguns dos quais com riscos significativos. Uma importante complicação destes fármacos é o de reativação de tuberculose latente. Estudos estimam que doentes com DII sob esta terapêutica têm um risco 4 vezes superior ao da população geral de reativação de tuberculose latente, que pode ser até 13 vezes superior, caso se associe fármacos como o metotrexato e a azatioprina. Uma meta-análise recente documentou que o risco de tuberculose é proporcional à incidência de tuberculose local. E, uma vez que Portugal é o país da Europa Ocidental com maior incidência de Tuberculose, e que, segundo dados de 2020, a região de Lisboa e Vale do Tejo, onde o Hospital Beatriz Ângelo (HBA) se insere, é a zona com maior incidência nacional, torna-se relevante estudar estes doentes. Os nossos objetivos incluem averiguar as manifestações clínicas de TB em doentes com DII sob anti-TNF-α e a eficácia do rastreio de tuberculose latente. Para este estudo, registos clínicos de doentes do HBA com DII que desenvolveram TB enquanto estavam sob terapêutica anti-TNF-α serão analisados.
The implementation of anti-TNFα drugs, such as Infliximab and Adalimumab, in the clinic has changed drastically the paradigm of Inflammatory Bowel Disease (IBD). However, they have the potential to cause side effects, some of which with significant risks. One of the most important side effects of these drugs is a greater risk of developing Tuberculosis (TB). Some studies refer to a 4-fold increased risk of reactivation of Latent TB in patients with IBD on anti-TNF-α compared to the general population, which can go up to 13-fold if the drugs are associated with azathioprine or methotrexate. A recent meta-analysis has found that the risk of TB is proportional to local TB incidence. Given that Portugal is the country with the highest incidence of Tuberculosis in Western Europe, and that the most affected region, according to data from 2020, is Lisboa and Vale do Tejo, in which the Hospital Beatriz Ângelo (HBA) is inserted, it is relevant that these patients are studied. Our objectives are to assess the clinical features of TB in anti-TNF-treated IBD patients from HBA and the efficacy of screening for latent TB. For this study, medical records from HBA of patients with IBD who developed TB whilst on anti-TNFα therapy will be reviewed.
The implementation of anti-TNFα drugs, such as Infliximab and Adalimumab, in the clinic has changed drastically the paradigm of Inflammatory Bowel Disease (IBD). However, they have the potential to cause side effects, some of which with significant risks. One of the most important side effects of these drugs is a greater risk of developing Tuberculosis (TB). Some studies refer to a 4-fold increased risk of reactivation of Latent TB in patients with IBD on anti-TNF-α compared to the general population, which can go up to 13-fold if the drugs are associated with azathioprine or methotrexate. A recent meta-analysis has found that the risk of TB is proportional to local TB incidence. Given that Portugal is the country with the highest incidence of Tuberculosis in Western Europe, and that the most affected region, according to data from 2020, is Lisboa and Vale do Tejo, in which the Hospital Beatriz Ângelo (HBA) is inserted, it is relevant that these patients are studied. Our objectives are to assess the clinical features of TB in anti-TNF-treated IBD patients from HBA and the efficacy of screening for latent TB. For this study, medical records from HBA of patients with IBD who developed TB whilst on anti-TNFα therapy will be reviewed.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Tuberculose Anti-TNF-α Doenças inflamatórias intestinais Gastroenterologia