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Immune checkpoint inhibitors and tuberculosis: an old disease in a new context.
The Lancet Oncology ( IF 41.6 ) Pub Date : 2020-01-01 , DOI: 10.1016/s1470-2045(19)30674-6 Ewan A Langan 1 , Victoria Graetz 2 , Judith Allerheiligen 2 , Detlef Zillikens 2 , Jan Rupp 3 , Patrick Terheyden 2
The Lancet Oncology ( IF 41.6 ) Pub Date : 2020-01-01 , DOI: 10.1016/s1470-2045(19)30674-6 Ewan A Langan 1 , Victoria Graetz 2 , Judith Allerheiligen 2 , Detlef Zillikens 2 , Jan Rupp 3 , Patrick Terheyden 2
Affiliation
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Tuberculosis, the leading cause of infection-related death in developing regions, is a leading cause of morbidity and mortality worldwide. Screening for, and treatment of, latent Mycobacterium tuberculosis infection is routine before initiation of anti-tumour necrosis factor α (anti-TNFα) agents in the management of psoriasis, Crohn's disease, and rheumatoid arthritis. By contrast, screening for latent tuberculosis before immune checkpoint inhibitor treatment in cancer is not routine, despite the increasing number of reports of primary infection with M tuberculosis or reactivation of latent M tuberculosis infection during such treatment. We present our experience with M tuberculosis screening in 70 patients who underwent immune checkpoint inhibitor therapy for metastatic skin cancer. Based on our understanding of the interaction between M tuberculosis and the immune system, we present the argument for tuberculosis screening before immune checkpoint inhibitor therapy and its use when considering anti-TNFα treatment for severe immune-related adverse events. We call for increased vigilance during immune checkpoint inhibition until its effects on tuberculosis pathophysiology are fully ascertained.
中文翻译：
免疫检查点抑制剂和结核病：新背景下的老病。
结核病是发展中地区与感染相关的死亡的主要原因，是全世界发病率和死亡率的主要原因。在开始治疗牛皮癣，克罗恩病和类风湿性关节炎的抗肿瘤坏死因子α（anti-TNFα）药物之前，应常规进行隐性结核分枝杆菌感染的筛查和治疗。相比之下，尽管在免疫检查点抑制剂治疗之前筛查潜伏性结核病不是常规的，尽管越来越多的报道称在这种治疗过程中原发性M结核感染或M潜伏性结核感染重新激活。我们介绍了70例接受过免疫检查点抑制剂治疗转移性皮肤癌的M结核病筛查的经验。基于我们对结核分枝杆菌与免疫系统之间相互作用的理解，我们提出了在免疫检查点抑制剂治疗之前进行结核病筛查的论点，以及在考虑针对严重免疫相关不良事件的抗TNFα治疗时其应用的观点。我们呼吁在免疫检查点抑制期间提高警惕，直到完全确定其对结核病病理生理的影响为止。
更新日期：2020-01-04
中文翻译：
免疫检查点抑制剂和结核病：新背景下的老病。
结核病是发展中地区与感染相关的死亡的主要原因，是全世界发病率和死亡率的主要原因。在开始治疗牛皮癣，克罗恩病和类风湿性关节炎的抗肿瘤坏死因子α（anti-TNFα）药物之前，应常规进行隐性结核分枝杆菌感染的筛查和治疗。相比之下，尽管在免疫检查点抑制剂治疗之前筛查潜伏性结核病不是常规的，尽管越来越多的报道称在这种治疗过程中原发性M结核感染或M潜伏性结核感染重新激活。我们介绍了70例接受过免疫检查点抑制剂治疗转移性皮肤癌的M结核病筛查的经验。基于我们对结核分枝杆菌与免疫系统之间相互作用的理解，我们提出了在免疫检查点抑制剂治疗之前进行结核病筛查的论点，以及在考虑针对严重免疫相关不良事件的抗TNFα治疗时其应用的观点。我们呼吁在免疫检查点抑制期间提高警惕，直到完全确定其对结核病病理生理的影响为止。
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