Answer to yesterday’s quiz: Which one of these factors is least likely to be a contraindication to the use of a tumor necrosis factor (TNF) inhibitor in a patient with Crohn’s disease? A. Active tuberculosis. B. Escherichia coli bacteremia. C. History of treated hepatitis C virus infection with an undetectable viral load. D. New York Heart Association class III heart failure. The correct answer is C. There is no evidence that hepatitis C is reactivated by TNF inhibitors. Because TNF inhibitors interfere with the normal inflammatory response, they are contraindicated in patients with uncontrolled infections. Before initiating therapy, patients should be screened for hepatitis B and evaluated for tuberculosis exposure (with chest radiography and an interferon-γ release assay, if the patient is already immunosuppressed, because a tuberculin skin test may be inconclusive). TNF inhibitors are contraindicated in patients with severe congestive heart failure (New York Heart Association class III or IV). nej.md/1f4pL6U
Posted on: Tue, 27 Aug 2013 19:00:00 +0000
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