Tumor Necrosis Factor Inhibitors and Fungal Infections

Abstract

The number of commercially available tumor necrosis factor (TNF)-α inhibitors has been increasing, including two new agents licensed since 2008. In addition to an expanding number of agents, there are also increasing licensed and “off label” clinical applications for the TNF inhibitors for the treatment of a variety of inflammatory or granulomatous disorders. Unfortunately, use of the TNF inhibitors has been associated with a wide variety of opportunistic infections, including fungal infections. Higher rates of morbidity and mortality from fungal infection in TNF inhibitor-treated patients have been observed, likely due to a delay in the diagnosis of invasive fungal infections and a tendency for these patients to develop severe and disseminated disease. Therefore, the US Food and Drug Administration issued a “black box” warning for clinicians in September 2008 to alert providers to the risks of fungal infections in patients treated with TNF-α inhibitors.