PDF(Pubmed)
Abstract：
BACKGROUND: Immunobiological drugs such as TNF-α inhibitors are valuable in rescue therapy for autoimmune diseases such as rheumatoid arthritis and inflammatory bowel disease (IBD), but they increase the risk of infectious complications. Histoplasmosis is a significant concern in patients living in endemic regions, however, few studies have assessed the incidence of Histoplasma infection during therapy, and classic estimates may underestimate the risk. This study aimed to produce an updated risk estimate of histoplasmosis in patients on TNF-α blocking therapy.
METHODS: This is a systematic review and meta-analysis of studies that contain parameters for calculating the risk of histoplasmosis in people who use TNF-α inhibitors, to produce a risk estimate.
RESULTS: We identified 11 studies with the necessary parameters for inclusion in the meta-analysis, most of which were from North America. The incidence rate of histoplasmosis found was 33.52 cases per 100,000 patients treated with TNF-ɑ inhibitors (95% CI 12.28-91.46). Considering only studies evaluating monoclonal antibodies, the calculated incidence was 54.88/100,000 patients treated (95%CI 23.45-128.34). In subgroup analysis, the incidence was much higher in patients with IBD compared to rheumatic diseases. There was significant heterogeneity among the studies.
CONCLUSIONS: The risk of histoplasmosis during TNF-α inhibitory therapy may be considerably higher than that found in classical estimates, especially in patients with IBD. There is a lack of studies evaluating histoplasmosis in large endemic areas, such as Central and South America.
METHODS: This is a systematic review and meta-analysis of studies that contain parameters for calculating the risk of histoplasmosis in people who use TNF-α inhibitors, to produce a risk estimate.
RESULTS: We identified 11 studies with the necessary parameters for inclusion in the meta-analysis, most of which were from North America. The incidence rate of histoplasmosis found was 33.52 cases per 100,000 patients treated with TNF-ɑ inhibitors (95% CI 12.28-91.46). Considering only studies evaluating monoclonal antibodies, the calculated incidence was 54.88/100,000 patients treated (95%CI 23.45-128.34). In subgroup analysis, the incidence was much higher in patients with IBD compared to rheumatic diseases. There was significant heterogeneity among the studies.
CONCLUSIONS: The risk of histoplasmosis during TNF-α inhibitory therapy may be considerably higher than that found in classical estimates, especially in patients with IBD. There is a lack of studies evaluating histoplasmosis in large endemic areas, such as Central and South America.
摘要：
背景：肿瘤坏死因子-α抑制剂等免疫生物学药物在类风湿关节炎和炎症性肠病（IBD）等自身免疫性疾病的挽救治疗中具有重要价值。但它们会增加感染并发症的风险。组织胞浆菌病是居住在流行地区的患者的重要问题，然而,很少有研究评估治疗期间组织胞浆感染的发生率，和经典的估计可能低估了风险。这项研究旨在对接受TNF-α阻断治疗的患者进行最新的组织胞浆菌病风险评估。
方法：这是对包含计算使用TNF-α抑制剂的人的组织胞浆菌病风险的参数的研究的系统综述和荟萃分析，产生风险估计。
结果：我们确定了11项具有纳入荟萃分析的必要参数的研究，其中大部分来自北美。发现的组织胞浆菌病的发生率为33.52例/100,000例接受TNF-α抑制剂治疗的患者（95％CI12.28-91.46）。仅考虑到评估单克隆抗体的研究，计算的发病率为54.88/100,000例接受治疗的患者(95CI23.45-128.34).在亚组分析中，与风湿性疾病相比，IBD患者的发病率要高得多。研究之间存在显著的异质性。
结论：在TNF-α抑制治疗期间，组织胞浆菌病的风险可能比经典估计中的风险高得多，尤其是IBD患者。缺乏在大型流行地区评估组织胞浆菌病的研究，例如中美洲和南美洲。
方法：这是对包含计算使用TNF-α抑制剂的人的组织胞浆菌病风险的参数的研究的系统综述和荟萃分析，产生风险估计。
结果：我们确定了11项具有纳入荟萃分析的必要参数的研究，其中大部分来自北美。发现的组织胞浆菌病的发生率为33.52例/100,000例接受TNF-α抑制剂治疗的患者（95％CI12.28-91.46）。仅考虑到评估单克隆抗体的研究，计算的发病率为54.88/100,000例接受治疗的患者(95CI23.45-128.34).在亚组分析中，与风湿性疾病相比，IBD患者的发病率要高得多。研究之间存在显著的异质性。
结论：在TNF-α抑制治疗期间，组织胞浆菌病的风险可能比经典估计中的风险高得多，尤其是IBD患者。缺乏在大型流行地区评估组织胞浆菌病的研究，例如中美洲和南美洲。
