Determination of tuberculin skin test for isoniazid prophylaxis in BCG vaccinated children who are using anti‐TNF agents for rheumatologic diseases

Abstract

Objective The use of tumor necrosis factor inhibitors (anti‐TNF) has a risk of activating latent tuberculosis infection (LTBI). This study was performed to investigate LTBI according to tuberculin skin test (TST) size and to determine the frequency of tuberculosis (TB) in bacillus Calmette‐Guerin (BCG)‐vaccinated children receiving anti‐TNF treatment for rheumatological disease. Materials and Methods The study consisted of 559 children. Information on demographics, anti‐TNF agents, TST size, and isoniazid (INH) prophylaxis was recorded. Patients (n = 254) with TST size ≥5 mm were divided into three groups according to TST size and INH prophylaxis: group 1, TST size 5 to 9 mm and no INH prophylaxis; group 2, TST size 5 to 9 mm with INH prophylaxis; and group 3, TST size ≥10 mm with INH prophylaxis. Results The 559 patients comprised 314 (56.3%) females and 245 (43.6%) males; they had a mean age of 13.1 ± 4.1 years. The mean TST size in all patients was 4.2 ± 4.7 mm. Group 1 consisted of 76 (29.9%) patients, group 2 consisted of 88 (34.6%) patients, and group 3 consisted of 90 (35.4%) patients. The mean TST sizes for the three groups were 6.8 ± 3.1 mm, 7.2 ± 3.2 mm, and 13.9 ± 2.8 mm, respectively. New TB was diagnosed in only two (0.35%) patients. Both of them were in group 3. Conclusions A TST size of ≥10 mm in BCG‐vaccinated children receiving anti‐TNF treatment may distinguish children at high risk for reactivation of LTBI.

Risk of tuberculosis in children with rheumatologic diseases treated with biological agents: A cross-sectional cohort study

“…Likewise, limited studies in children, even in areas with an intermediate incidence of TB, indicated that biological agents did not v Tuberculosis in therapy with biological drugs significantly increase the risk of TB in children with juvenile idiopathic arthritis. 20,21 However, the majority of studies derive their results on a shorter period of follow-up. 22 All patients in the current study were followed for an average of more than three years.…”

“…Although the recommendations vary depending on the economic status and TB prevalence of a country, the TST, IGRA, or both, in combination with chest radiographs, are the approved LTBI screening procedures. 21,23,24 While the World Health Organization recommends TST or IGRA for LTBI screening, there is no gold standard for the LTBI diagnosis. 19 There are no well-designed randomized controlled trials in children examining the priority of TST or IGRA.…”