Does isoniazid chemoprophylaxis increase the frequency of hepatotoxicity in patients receiving anti-TNF-α agent with a disease-modifying antirheumatic drug?

Abstract

Objective: The aim of this study is to determine the incidence of isoniazid (INH)-related hepatotoxicity in patients with rheumatologic diseases receiving tumor necrosis factor-α (TNF-α) antagonists along with a disease-modifying antirheumatic drug (DMARD). Material and Methods:We have retrospectively evaluated 87 patients receiving anti-TNFα agents who were followed up between June 2005and February 2010 at our rheumatology department. Sixty-one of 87 patients have received INH prophylaxis for 9 months for latent tuberculosis infection.Results: A total of 61 (70.1%) of 87 patients used INH prophylaxis (Group I), while the remaining 26 (29.9%) (Group II) had not; 53 patients had used any DMARD in Group I, while 21 patients had used in Group II. No significant differences were found among Group I and II with respect to clinical features. When two groups were compared, in Group I, elevations of liver enzymes were detected in five patients (8.1%) who had normal baseline values. Among these patients, hepatotoxicity developed in two patients. Hepatotoxicity developed one patient in Group II (p=0.85). Conclusion:INH chemoprophylaxis was well tolerated in patients using anti-TNF-α agent and a DMARD. It seems not to be a strong risk factor for hepatotoxicity. However, comorbidities and other drugs used may be additional factors in the elevation of transaminases.

Isoniazid use, effectiveness, and safety for treatment of latent tuberculosis infection: a systematic review

“…Three of the included studies did not report where they were conducted 54 , 62 , 88 . The most frequent settings were: outpatient clinics and clinics (n = 41) 24 - 26 , 30 , 35 - 38 , 40 - 43 , 46 - 52 , 56 - 58 , 61 , 67 , 68 , 71 - 73 , 75 , 81 , 82 , 84 , 85 , 87 , 89 - 95 ; hospitals (n =19) 24 , 28 , 39 , 40 , 45 , 53 , 55 , 59 , 60 , 64 , 66 , 70 , 74 , 76 , 77 , 80 , 78 , 79 , 83 ; and penitentiaries (n = 4) 29 , 31 , 33 , 63 .…”

“…Regarding the various treatment alternatives for LTBI globally, among the studies analyzed, 53 used INH for 9 months 24 - 28 , 30 - 34 , 38 - 46 , 49 - 54 , 58 , 61 , 63 , 64 , 67 , 69 , 72 - 74 , 76 , 77 - 79 , 80 , 81 , 82 - 87 , 89 , 91 , 92 , 94 , 95 , 40 used INH for 6 months 24 , 26 , 27 , 29 , 34 - 36 , 39 , 42 - 44 , 47 - 49 , 53 , 55 , 56 , 57 , 59 - 62 , 64 , 65 , 67 , 68 , 70 , 71 , 72 , 74 , 75 , 84 , 86 - 90 , 93 , 94 , 95 , and two used INH for 12 months 66 . Rifampicin monothera...…”

“…Thirty-five studies did not assess INH effectiveness as a preventive therapy for TB with INH 24 , 26 - 27 , 29 , 31 - 33 , 35 , 38 - 40 , 42 - 45 , 47 , 51 , 52 , 54 , 58 , 59 , 64 , 65 , 67 - 70 , 74 , 77 , 78 , 81 , 82 , 90 , 95 , 90 .…”

“…In general, the studies included in this systematic review demonstrated fair methodological quality. Thirty-six studies were considered to have good methodological quality 25 - 28 , 32 , 34 , 39 , 41 , 42 - 44 , 46 , 47 , 49 , 50 , 52 , 54 , 58 , 61 , 62 , 64 , 66 - 68 , 70 , 74 , 77 , 79 , 80 , 81 , 83 , 87 , 88 , 93 and 37 had “regular” quality 24 , 29 - 31 , 33 , 35 - 38 , 40 , 45 , 48 , 51 , 53 , 55 - 57 , 59 , 60 , 63 , 65 , 69 , 71 - 73 , 75 , 76 , 78 , 82 , 84 - 86 , 89 , 90 - 92 , 94 , 95 …”