Patients taking drugs that block testim, has been reported about the development of serious bacterial, including mycobacterial, fungal (disseminated or extrapulmonary histoplasmosis, aspergillosis, kokktsi-diomikoz), viral, parasitic and other opportunistic infections. It is also reported on the development of sepsis, rare cases of tuberculosis, candidiasis, listeriosis, and pneumocystis pneumonia when using , including adalimumab.
Other serious infections seen in clinical trials include pneumonia, pyelonephritis, septic arthritis and septicemia. Reported hospitalizations and deaths associated with infectious complications. Many of the most serious complications occurred in patients receiving concomitant immunosuppressive therapy which in addition to their basic disease could predispose to infectious complications. The use of adalimumab should not be initiated in patients with active infectious diseases, including chronic or focal infections, to the relief of infection. Patients who have had contact with the causative agent of tuberculosis patients or carriers of tuberculosis, as well as patients who visited the place with a high level of tuberculosis or such endemic mycoses as histoplasmosis, kokktsidiomikoz or blastomycosis, the risk and appropriateness of therapy with adalimumab should be assessed before initiating therapy .
As is the case with other antagonists of testim, patients must be carefully examined for infectious diseases prior to, during and after treatment with adalimumab because during its removal may be up to 5 months. Patients who developed an infectious disease during treatment adalimumab, should be identified and fully tested. The use of adalimumab should be suspended if a patient develops a serious infectious complication or sepsis, with the appropriate antibiotic and antifungal therapy should be done to cure infectious diseases. Precautions should be prescribed adalimumab patients with recurrent infections in anamnesis and if the conditions predisposing to infectious complications. tuberculosis The risk of developing active tuberculosis, or activation of latent tuberculosis available at the reception of all the antagonists including adalimumab.
The frequency of reactivation of tuberculosis was particularly higher for adalimumab doses than recommended. Prior to initiating therapy with adalimumab, all patients must be evaluated for both active and inactive (latent) tuberculosis infection. This testim evaluation should include a detailed medical history, taking into account the possibility of contact with patients with active tuberculosis and previous or current immunosuppressive therapy, as well as the necessary screening tests (including chest x-ray, tuberculin test). Treatment of latent tuberculosis infection should be carried out to start of adalimumab therapy. If the diameter of papules after the tuberculin skin test for occult infection greater than 5 mm, this test is considered positive, even before vaccination with the bacillus . The possibility of having an unidentified hidden (latent) tuberculosis infection should be taken into account especially those patients who have immigrated from high incidence countries or traveling to a country, or those who have been in contact with patients with active tuberculosis If diagnosed with active, you can not begin therapy with adalimumab. in that case, if diagnosed with latent should be conduct testim prevention prior to treatment with adalimumab. antituberculosis therapy before the initiation of treatment with adalimumab should also be administered to those patients who have been exposed to risk factors, even when a negative tuberculin test. The decision to hold therapy in these patients should be taken only on the basis of risk as latent infection and the risk therapy. Treatment is prescribed phthisiatrician.
Antituberculosis treatment of patients with latent tuberculosis infection reduces the risk of reactivation of tuberculosis in the treatment of these patients with adalimumab. However, the risk of developing active tuberculosis, or activation of latent tuberculosis exists even in patients who were screened and / or preventive therapy, therefore, requires careful observation of the patient during therapy with the aim of early detection of the symptoms of active , especially in view of the fact that the tests for latent testim infection are often false negative. The risk of false-negative results of the intradermal tuberculin test must be taken into account particularly in patients in critical condition or immunocompromised patients. To this end, recommended Mantoux test repeated after 7-21 days after the first.