Background Prophylaxis of tuberculosis in patients treated with anti-tumor necrosis factor (Anti-TNF) prevents the latent tuberculosis infections (LTBI). But incidence rate of tuberculosis with anti-TNF therapy in tuberculosis-endemic area is higher than in other areas despite strict prophylaxis.
Objectives We analyzed incidences and characteristics of patients with reactivation of LTBI and new tuberculosis infection.
Methods We identified 548 patients treated with anti-TNF in tertiary care center from June 2003 through June 2010. The number of patients with ankylosing spondylitis, rheumatoid arthritis, psoariatic arthritis, spondyloarthropathy and behcet’s disease were 316, 215, 11, 3 and 3 respectively. Their medical records including history of tuberculosis infection were reviewed.
Results Among 548 patients, 508 patients took tuberculosis screening test and 266 patients had LTBI prophylaxis. Nevertheless, we observed 11 cases of tuberculosis (2.0%) and the incidence rate of tuberculosis was 969.66 per 100,000 person-years. Patients infected by tuberculosis were 6 non-LTBI, 4 LTBI received prophylaxis and 1 without screening test. The mean duration of anti-TNF therapy was 20.75±18.61 months and patients of extrapulmonary tuberculosis were 9. Among 11 tuberculosis patients, 3 non-LTBI patients and 2 LTBI patients who received prophylaxis were infected by tuberculosis after anti-TNF therapy of 12 months and their mean duration of anti-TNF therapy was 40.8 months. In addition, three non-LTBI patients treated with anti-TNF therapy for less than 12 months were infected by new tuberculosis or reactivated LTBI with false-negative screening test.
Conclusions The incidence of tuberculosis in patients treated with anti-TNF was higher than other previous reports. This result show that the reactivation of LTBI and development of new tuberculosis infection as a long period of anti-TNF therapy for the endemic area. Screening and prophylaxis of LTBI are important but we also have to be concerned about new tuberculosis infection during anti-TNF therapy.
Dixon WG, Hyrich KL, Watson KD, Lunt M, Galloway J, Ustianowski A, et al. Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (BSRBR). Annals of the rheumatic diseases. 2010 Mar; 69(3):522-528.
Tubach F, Salmon D, Ravaud P, Allanore Y, Goupille P, Breban M, et al. Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy: The three-year prospective French Research Axed on Tolerance of Biotherapies registry. Arthritis and rheumatism. 2009 Jul; 60(7):1884-1894.
Disclosure of Interest None Declared
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