Background Tumor necrosis factor-α (TNF-α) antagonists bring new hope for treating rheumatoid arthritis (RA) over the past decade. However, the subsequent increased risk of developing tuberculosis (TB) is one of the major drawbacks in patients with TNF-α antagonists.
Objectives The aim of this study was to evaluate the overall incidence rate of TB in RA patients treated with TNF-α antagonists and compare of incidence rate according to type and duration of TNF-α antagonists, and history of treatment for latent TB infection (LTBI) in South Korea, TB-endemic area.
Methods All RA patients treated with TNF-α antagonists registered with the Korea National Health Insurance Review and Assessment Service (HIRA) between January 2006 and December 2011 were included and retrospectively analyzed. The incidence of LTBI by screening test and of TB after starting TNF-α antagonists were reviewed.
Results Total 3,573 RA patients with TNF-α antagonists were observed. Of these, 735 (21.1%) patients were treated with LTBI before starting TNF-α antagonists. One hundred-thirty two (2.6%) patients developed TB during follow-up period, and the incidence rate of TB was 583.7 per 100,000 person years (PY). The incidence rate of TB in patient with infliximab revealed 1408.1 per 100,000 PY which is the highest rate, followed by adalimumab of 1211.4 per 100,000 PY and etanercept of 618.4 per 100,000 PY. Forty-five (1648.8 per 100,000 PY), 24 (1038.2 per 100,000 PY), and 63 (647.5 per 100,000 PY) cases of TB were observed during first 6 months, 7-12 months, and 13 months or more after starting TNF-α antagonists, respectively. Among the patients who developed TB, 13 (9.8%) patients had completed treatment of LTBI. The incidence rate of TB demonstrated 477.6 per 100,000 PY and 987.7 per 100,000 PY in patients with and without history of treatment of LTBI, respectively.
Conclusions The risk of TB infection increased in RA patients treated with infliximab, and during first 6 months with TNF-α antagonists. Relatively lower risk of TB infection were observed in patients treated with etanercept, and during 13 months and more after starting TNF-α antagonists compare to the rest of the RA patients. RA patients with TNF-α antagonists need watchful observation for TB infection, even in patients who had completed treatment of LTBI.
Disclosure of Interest None declared
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