Eventos adversos relacionados a medicamentos em pacientes submetidos ao tratamento com anti – fator de necrose tumoral alfa

Abstract

Immunobiological agents are targeted to the regulation of the immune response, and for this reason, they may control symptoms and progression of autoimmune diseases. They can act as soluble receptors that bind to TNF, blocking effects on target cells, also as recombinant proteins that mimic the effect of the original cytokine. TNF antagonists are drugs used to treat chronic inflammatory diseases such as rheumatoid arthritis, juvenile rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. Despite their beneficial effects, these drugs may be implicated in adverse events. The present study aimed to investigate the occurrence of adverse events in patients with chronic inflammatory diseases, undergoing treatment with anti-TNF therapy in a tertiary hospital. We evaluated 204 charts in the period 2010 to 2011, and found 139 adverse drug events in 87 (42.6%) patients. Patients who had adverse events were predominantly female (64.4%) and the most affected age group was 21-55 years. Adverse events were the result of adverse reactions (74%), ineffective treatment (14%), reactions during intravenous infusion (8%), reactions at the site of subcutaneous administration (4%). Among the cases where treatment was ineffective, 8 were under treatment with infliximab, 7 under use of etanercept and 5, adalimumab use. It was necessary to have discontinuation of treatment in all cases. Among the adverse reactions (103), some clinical manifestations (n = 19) led to the suspension of treatment. The other events led to the temporary postponement of treatment until resolution of the clinical manifestation and / or were employed the use of antihistamines and other antidotes. The clinical features present in adverse reactions to anti-TNF were upper respiratory tract infections, urinary tract infection and liver abnormalities. Other manifestations such as skin infections, gastrointestinal and hematological alterations, more serious infections such as pneumonia, herpes zoster, tuberculosis also occurred in a lower frequency. The present work shows pharmacovigilance be exercised effectively in patients who are undergoing treatment with anti-TNF, because of their high risk of suffering adverse events. In future projects, it is necessary to perform cohort studies, what it would allow to have a more complete evaluation of each patient.