Infection risk associated with anti-TNF-α agents: A review

Giuseppe Murdaca, Francesca Spanò, Miriam Contatore, Andrea Guastalla, Elena Penza, Ottavia Magnani, Francesco Puppo

Research output: Contribution to journalArticlepeer-review


Introduction: TNF-α is a pro-inflammatory cytokine known to a have a key role in the pathogenesis of chronic immune-mediated diseases. TNF-α inhibitors can be administered either as monotherapy or in combination with other anti-inflammatory or disease-modifying anti-rheumatic drugs (DMARDs) to treat chronic immune-mediated diseases.Areas covered: Patients receiving TNF-α inhibitors are at high risk of infections. Based on our experience, in this paper, we discuss the risk of infections associated with the administration of TNF-α inhibitors and the strategies for mitigating against the development of these serious adverse events.Expert opinion: Infliximab more so than etanercept appears to be responsible for the increased risk of infections. Re-activation of latent tuberculosis (LTB) infection and the overall risk of opportunistic infections should be considered before beginning TNF-α inhibitor therapy. A careful medical history, Mantoux test and chest-x-ray should always be performed before prescribing TNF-α inhibitors. Particular attention should be paid to risk factors for Pneumocystis jirovecii infection. Hepatitis B and C virological follow-up should be considered during TNF-α inhibitor treatment. Finally, patients who are at high risk of herpes zoster (HZ) reactivation would benefit from a second vaccination in adulthood when receiving TNF-α inhibitors.

Original languageEnglish
Pages (from-to)571-582
Number of pages12
JournalExpert Opinion on Drug Safety
Issue number4
Publication statusPublished - Apr 1 2015


  • Hepatitis B virus
  • Hepatitis C virus
  • Infections
  • TNF-α inhibitors
  • Tuberculosis

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Medicine(all)


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