Background The risk of latent tuberculosis (TB) reactivation in patients treated with biologics for rheumatic inflammatory diseases is well-established. This is a great concern especially in countries with high TB burden. Most national guidelines recomend screening for latent TB before the initiation of biologic treatament. In our country the mandatory screening consists of combination of patient's personal history evaluation asscociated with tuberculin skin test (TST positive >5 mm), QuantiFERON TB gold test and chest x-ray.
Objectives To evaluate the efficacy of correct secreening for latent tuberculos in patients treated with biologics.
Methods 91 rheumatoid arthritis and ankylosing spondylitis patients (72.6% females, 27.4% males, mean age 50.8 years, mean disease duration 68.9 months) treated with biologics betwee Jan 2009- Dec2013 were prospectively analysed. When indicated (TST≥5mm and/or QuantiFERON positive) isoniazid treatment for latent TB was initiated for 9 months and the chosen biologic started 1 month later. Our cohort excluded patients treated for less than 3 months with biologics.
Results 24.5% were treated with Infliximab (mean treatment duration 29.7±14.1), 10,6% with Etanercept (mean treatment 33±11.9), 25,5% with Adalimumab (mean treatment 22.6±13.1), 4,3% with Golimumab (mean duration 22±8), 4.3% with Certolizumab (mean duration 14±5.88), 17% with Tocilizumab (mean duration 25.8±8.3) and 16% with Rituximab (mean treatment 25.8±8.32 months). Three (3.3%) patients developed active TB. All of them had negative screening (TB history and contact, QuantiFERON and TST) and all were BCG vaccinated since childhood. One of these patients was on Golimumab for 18 months; the second patient was on certolizumab pegol for 11 months; and the third one on Iinfliximab for 16 months. One patient developed a solitary lung tuberculom and two extralung involvement (one ganglionar and one multiorgan TB). None of the patients with latent TB (consecutively treated with isoniazid) developed TB during biological treatment. Treatment duration was negatively correlated to TB development (r=-0.219, P=0.037).
Conclusions Negative screening tests for latent TB are not sufficient for preventing TB development in patients treated with biological agents. Statistical analysis suggested that constant monitoring of patients treated with biological agents should be done, especially in the first months.
Disclosure of Interest None declared
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