Background Biological therapy have revolutionized the treatment of some autoimmune diseases, such as rheumatoid arthritis (RA), and spondyloarthropathies (SpA). Patients receiving biologics have a increased risk of opportunistic infections, particularly of reactivating latent tuberculosis (LTB).
Objectives To describe the presence of LTB and viral hepatitis in a cohort of patients (pts) with biologic therapy.
Methods Cross-sectional study. 157 patients of a rheumatology center treated with biological therapy were evaluated. Medical records were reviewed. Variables: sex, mean age, diagnosis, current biological therapy, PPD (>10mm), hepatitis B virus surface antigen reactivity, hepatitis C virus antibody reactivity, chest x-ray, biological therapy since 2001, antinuclear antibodies (ANAS), and associated autoimmunity. Descriptive analysis was done for qualitative and categorical variables (percentages and averages) using STATA11.
Results In 23 patients (14.7%) was documented LTB. 12 pts (52.2%) are women and 11 pts (47.8%) are male. Mean age: 50,6 y/o. 13 pts (56.5%) have diagnosis of SpA, 9 patients (39,1%) RA, and 1 patient (4.37%) psoriatic arthritis (PsA). 9 pts (39,1%) receive Adalimumab, 7 pts (30,43%) Infliximab, 3 pts (13%) Etanercept, 3 pts (13%) Rituximab, and 1 pt (4,4%) Tocilizumab.
Since year 2001, 16 patients (69,6%) have received just one biologic as treatment, 4 pts (17.4%) 3 biologics, 2 pts (8,7%) 2 biologics, and 1 pts (4,3%) 6 biologics. Infliximab is the biologic more prescribed (12 pts, 52,2%) as first choice since 2001. Adalimumab (57,1%) is the one most formulated in the group that have received more tan one biologic. All patients chest X-ray were reported as normal. 14 pts (60.87%) have positive ANAS. Associated autoimmunity: 3 pts (13.4%) uveitis, and 2 pts (8.70%) Sjogren syndrome (SS). Pneumology prescribed all patients Isoniazid for minimun 9 months. The biologic was started o continued after three months on Isoniazid.
In 5 patients (3.18%) was documented seropositivity for Hepatitis B (HBV). 3 pts (60%)) are men and 2 pts (40%) are women. Mean age: 56.1 y/o. 4 pts (80%) have diagnosis of RA, and 1 pt (20%) have diagnosis of SpA. 2 pts receive adalimumab (40%), 2 pts Etanercept (40%), and 1 pt Abatacept (20%). Since year 2001, 1 pt (20%) have received 2 biologics, and 1 pt (20%) 4 biologics. Infliximab (40%) and Adalimumab (40%) are the biologic more prescribed. 2 pts (40%) have positive ANAS. Associated autoimmunity: 1 pt (20%) inflammatory bowel disease, and 1 pt (20%) SS. In a 58 y/o female patient with diagnosis of SpA, in treatment with Adalimumab was found seropositivity for Hepatitis C. Associated autoimmunity: Uveitis. All patients were evaluated by gastroenterology. None of these biologic was discontinued.
Conclusions LBT prevalence in this cohort is higher that reported in other cohorts1. Adalimumab is the biologic more used in patients with LBT. Normal chest x-ray does not exclude LTB. HBV prevalence is similar to previous data reported.1The surveillance of LBT and viral hepatitis must be mandatory in patients receiving biological therapy.
Nacci F, Matucci-Cerinic M. Tuberculosis and other infections in the anti-tumour necrosis factor-alpha (anti-TNF-α) era. Best Pract Res Clin Rheumatol. 2011 Jun;25(3):375-88.
Disclosure of Interest None Declared
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