Monoklonálne protilátky proti faktoru nádorovej nekrózy (TNF) alebo solubilný TNF viažuci receptor sa stali neoceniteľnou liečbou chronických zápalových ochorení ako sú reumatoidná artritída, zápalové ochorenie čreva a psoriáza. Pacienti, liečení TNF-antagonistami, majú zvýšené riziko reaktivácie latentných infekcií, najmä tuberkulózy. Relatívne riziko vzniku tuberkulózy stúpa po liečbe TNF-antagonistami až 25-násobne, podľa klinického prostredia a použitého TNF-antagonistu. Toto spoločné vyhlásenie konsenzuálnej skupiny TBNET zhŕňa súčasné poznatky a názory odborníkov, a súčasne poskytuje odporúčania, založené na dôkazoch, na zníženie tuberkulózneho rizika u pacientov s plánovanou liečbou TNF-antagonistami.

Anti-tumour necrosis factor (TNF) monoclonal antibodies or soluble TNF receptor have become an invaluable treatment against chronic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease and psoriasis. Individuals who are treated with TNF antagonists are at increased risk of reactivating latent infections, especially tuberculosis. Following TNF antagonist therapy, the relative risk for tuberculosis is increased up to 25 times, depending on the clinical setting and the TNF antagonist used. This TBNET consensus statement summarizes current knowledge and expert opinions and provides evidence-based recommendations to reduce the tuberculosis risk among candidates for TNF antagonist therapy.

• MeSH
• dítě MeSH
• dospělí MeSH
• inhibitory TNF MeSH
• interferon gama škodlivé účinky   terapeutické užití   MeSH
• isoniazid MeSH
• klinické laboratorní techniky MeSH
• komorbidita MeSH
• lidé MeSH
• medicína založená na důkazech normy   trendy   MeSH
• nežádoucí účinky léčiv MeSH
• revmatoidní artritida etiologie   farmakoterapie   komplikace   MeSH
• rifampin MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• tuberkulóza diagnóza   etiologie   farmakoterapie   MeSH
• tumor nekrotizující faktory škodlivé účinky   terapeutické užití   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé MeSH

RATIONALE: Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less, and cure rates are even lower. OBJECTIVES: To document the management and treatment outcome in patients with MDR-TB in Europe. METHODS: We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by World Health Organization and alternative simplified definitions by the Tuberculosis Network European Trialsgroup (TBNET). MEASUREMENTS AND MAIN RESULTS: A total of 380 patients with MDR-TB were recruited and followed up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median, 111 vs. 28 d), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying World Health Organization outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence countries. Simplified outcome definitions that include 1 year of follow-up after the end of treatment showed similar frequency of relapse-free cure in low- (58.3%), intermediate- (55.8%), and high-incidence (57.1%) countries, but highest frequency of failure in high-incidence countries (24.1% vs. 14.6%). CONCLUSIONS: Conventional standard MDR-TB treatment regimens resulted in a higher frequency of failure compared with individualized treatments. Overall, cure from MDR-TB is substantially more frequent than previously anticipated, and poorly reflected by World Health Organization outcome definitions.

• MeSH
• antituberkulotika terapeutické užití   MeSH
• incidence MeSH
• kohortové studie MeSH
• lidé MeSH
• multirezistentní tuberkulóza farmakoterapie   epidemiologie   MeSH
• prospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

• MeSH
• dospělí MeSH
• falešně negativní reakce * MeSH
• genetická variace MeSH
• interferon gama metabolismus   MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• mezinárodní spolupráce MeSH
• multivariační analýza MeSH
• průřezové studie MeSH
• průzkumy a dotazníky MeSH
• regresní analýza MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• test pomocí interferonu gama metody   MeSH
• tuberkulóza diagnóza   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• dopisy MeSH
• multicentrická studie MeSH

BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.ConclusionsCountry of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.

• MeSH
• incidence MeSH
• lidé MeSH
• průřezové studie MeSH
• tuberkulóza * diagnóza   epidemiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH
• Somálsko MeSH

Monoklonálne protilátky proti faktoru nádorovej nekrózy (TNF) alebo solubilný TNF viažuci receptor sa stali neoceniteľnou liečbou chronických zápalových ochorení, ako sú reumatoidná artritída, zápalové ochorenie čreva a psoriáza. Pacienti liečení TNF-antagonistami majú zvýšené riziko reaktivácie latentných infekcií, najmä tuberkulózy. Relatívne riziko vzniku tuberkulózy stúpa po liečbe TNF-antagonistami až 25-násobne, podľa klinického prostredia a použitého TNF-antagonistu. Toto spoločné vyhlásenie konsenzuálnej skupiny TB NET zhŕňa súčasné poznatky a názory odborníkov a zároveň poskytuje odporúčania, založené na dôkazoch, na zníženie tuberkulózneho rizika u pacientov s plánovanou liečbou TNF-antagonistami.

Anti-tumour necrosis factor (TNF) monoclonal antibodies or soluble TNF receptor have become an invaluable treatment against chronic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel diseases and psoriasis. Individuals who are treated with TNF antagonists are at increased risk of reactivating latent infectious disease, especially tuberculosis. Following TNF antagonist therapy, the relative risk for tuberculosis is increased up to 25 times, depending on the clinical setting and the TNF antagonist used. This TBNET consensus statement summarizes current knowledge and expert opinions and provides evidence-based recommendations to reduce the risk of tuberculosis in candidates for TNF antagonist therapies.