Characteristics Predicting Tuberculosis Risk under Tumor Necrosis Factor-α Inhibitors: Report from a Large Multicenter Cohort with High Background Prevalence.

Abstract

OBJECTIVE:

Screening strategies for latent tuberculosis (TB) before starting tumor necrosis factor (TNF)-α inhibitors have decreased the prevalence of TB among patients who are treated with these agents. However, despite vigilant screening, TB continues to be an important problem, especially in parts of the world with a high background TB prevalence. The aim of this study was to determine the factors related to TB among a large multicenter cohort of patients who were treated with anti-TNF.

METHODS:

Fifteen rheumatology centers participated in this study. Among the 10,434 patients who were treated with anti-TNF between September 2002 and September 2012, 73 (0.69%) had developed TB. We described the demographic features and disease characteristics of these 73 patients and compared them to 7695 patients who were treated with anti-TNF, did not develop TB, and had complete data available.

RESULTS:

Among the 73 patients diagnosed with TB (39 men, 34 women, mean age 43.6 ± 13 yrs), the most frequent diagnoses were ankylosing spondylitis (n = 38) and rheumatoid arthritis (n = 25). More than half of the patients had extrapulmonary TB (39/73, 53%). Six patients died (8.2%). In the logistic regression model, types of anti-TNF drugs [infliximab (IFX), OR 3.4, 95% CI 1.88-6.10, p = 0.001] and insufficient and irregular isoniazid use (< 9 mos; OR 3.15, 95% CI 1.43-6.9, p = 0.004) were independent predictors of TB development.

CONCLUSION:

Our results suggest that TB is an important complication of anti-TNF therapies in Turkey. TB chemoprophylaxis less than 9 months and the use of IFX therapy were independent risk factors for TB development.

• Authors: Bunyamin Kisacik, Omer Nuri Pamuk, Ahmet Mesut Onat, Sait Burak Erer, Gulen Hatemi, Yesim Ozguler, Yavuz Pehlivan, Levent Kilic, Ihsan Ertenli, Meryem Can, Haner Direskeneli, Gökhan Keser, Fahrettin Oksel, Ediz Dalkilic, Sedat Yilmaz, Salih Pay, Ayse Balkarli, Veli Cobankara, Gözde Yildirim Cetin, Mehmet Sayarlioglu, Ayse Cefle, Ayten Yazici, Ali Berkant Avci, Ender Terzioglu, Suleyman Ozbek, Servet Akar, Ahmet Gul
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 43 Issue 3 Pg. 524-9 (Mar 2016) ISSN: 0315-162X [Print] Canada
• PMID: 26773107 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Antirheumatic Agents
• Biological Products
• Tumor Necrosis Factor-alpha

Topics

• Adult
• Antirheumatic Agents (adverse effects, therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Biological Products (adverse effects, therapeutic use)
• Female
• Humans
• Latent Tuberculosis (diagnosis)
• Male
• Middle Aged
• Prevalence
• Risk
• Spondylitis, Ankylosing (drug therapy)
• Tuberculosis (epidemiology, etiology)
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)