Document Detail

Tumor necrosis factor inhibitors and lung disease: a paradox of efficacy and risk.
MedLine Citation:
PMID:  19914686     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Tumor necrosis factor inhibitors (TNFi) are being increasingly used for a wide range of indications. There are increasing reports of pulmonary toxicity related to the use of TNFi. In this review, we have attempted to synthesize the available literature regarding noninfectious complications related to TNFi use.
METHODS: We reviewed case reports, case series, and clinical trials accessed from the PubMed database (, European League Against Rheumatism web archive (, and the British Society of Rheumatology Biologics Register Newsletter website ( using 23 search terms.
RESULTS: There are increasing data available about use of TNFi in treatment of systemic inflammatory rheumatologic disorders and their attempted use for various pulmonary indications. Currently reported noninfectious pulmonary complications related to TNFi use include most commonly granulomatous disease and pulmonary fibrosis/interstitial lung disease and rarely alveolar hemorrhage and antisynthetase syndrome. De novo granulomatous disease seems to be mostly reversible, whereas pulmonary fibrosis carries the worst prognosis especially in the setting of prior lung fibrosis.
CONCLUSIONS: Serious and potentially fatal pulmonary toxicity has been reported during the use of TNFi, specifically from pulmonary fibrosis. Increased awareness during trial design and increased postmarketing surveillance is needed to provide more information about the epidemiology of these complications. Early recognition of these complications may help avert therapeutic misadventures.
Atul A Khasnis; Leonard H Calabrese
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-11-14
Journal Detail:
Title:  Seminars in arthritis and rheumatism     Volume:  40     ISSN:  1532-866X     ISO Abbreviation:  Semin. Arthritis Rheum.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-29     Completed Date:  2011-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1306053     Medline TA:  Semin Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  147-63     Citation Subset:  IM    
Copyright Information:
© 2010 Elsevier Inc. All rights reserved.
Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA.
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MeSH Terms
Antirheumatic Agents / adverse effects*
Databases, Factual
Lung Diseases / chemically induced*
Rheumatic Diseases / drug therapy*
Risk Factors
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
Reg. No./Substance:
0/Antirheumatic Agents; 0/Tumor Necrosis Factor-alpha

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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