Follow‐up of 1887 patients receiving tumor necrosis‐alpha antagonists: Tuberculin skin test conversion and tuberculosis risk

Çağatay, Tülin; Bingöl, Züleyha; Kıyan, Esen; Yeğin, Zeynep Arzu; Okumuş, Gülfer; Arseven, Orhan; Erkan, Feyza; Gulbaran, Ziya; Erelel, Mustafa; Ece, Turhan; Çağatay, Penbe; Kılıçaslan, Zeki

doi:10.1111/crj.12726

Cited by 16 publications

(20 citation statements)

References 27 publications

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“…As in previous investigations, our study showed a high incidence of TB in patients with rheumatic diseases exposed to TNF inhibitors therapy: 735.29 per 100,000 exposed, approximately 18 times higher than that of the general population of the state of Rio Grande do Sul (39.5 per 100,000). [24]…”

Section: Discussionmentioning

confidence: 99%

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A population-based study of tuberculosis incidence among rheumatic disease patients under anti-TNF treatment

et al. 2019

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IntroductionTuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. The advent of immunobiologic therapy with TNF inhibitors agents, has been associated with a significant increase in incident cases of tuberculosis in this population.ObjectiveTo estimate the incidence of tuberculosis in patients receiving TNF inhibitors therapy for rheumatic diseases. As secondary objectives, we sought to evaluate mortality and the clinical impact of screening for latent tuberculosis infection.MethodsThis retrospective study included patients with rheumatic diseases of Public Health System from the Brazilian state, a high TB incidence area, who received prescriptions of TNF inhibitors agents between 2006 and 2016.ResultsA total of 5853 rheumatic disease patients were included. Patients were predominantly women (68.7%) aged 49.5 (± 14.7) years old. Forty-three cases of TB were found (2.86 cases per 1000 person-years; 18 times higher than in the general population). Adalimumab and certolizumab users presented a higher risk for TB development compared to etanercept users (RR: 3.11, 95%CI 1.16–8.35; 7.47, 95%CI 1.39–40.0, respectively). In a subgroup of patients, screening for latent tuberculosis infection was performed in 86% of patients, and 30.2% had a positive tuberculin skin test. Despite latent TB treatment, TB was diagnosed in 2 out of 74 (2.7%) patients. Overall, TB diagnosis did not increase mortality.ConclusionIn this population-based study of rheumatic disease patients from a high incident area, TNF inhibitor exposure was associated with an 18-time increased TB incidence. Adalimumab and certolizumab were associated with greater and earlier TB diagnosis compared to etanercept.

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Section: Discussionmentioning

confidence: 99%

“…[23] In patients given infliximab, risk could be up to 30 times greater than in the general population. [24,25]…”

Section: Introductionmentioning

confidence: 99%

A population-based study of tuberculosis incidence among rheumatic disease patients under anti-TNF treatment

et al. 2019

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“…The overall incidence (all diagnoses) was 423/100,000 PY. The use of adalimumab (9.5-fold increase), male gender (15.6-fold increase) and a history of TB (11.5fold increase) were indicated as risk factors for TB in the multivariate analysis [162] (2B). The other study is a casecontrol study in which 73 (52.1% patients with AS) cases of TB among anti-TNFα drug users were compared with 7695 (50.6% patients with AS) controls, namely, anti-TNFα drug users without TB.…”

Section: Does the Safety Of Biologics Differ In Patients With Axial Spa?mentioning

confidence: 99%

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis – 2019

et al. 2020

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Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis. The purpose of these guidelines is to bring evidencebased information on clinical management of axial SpA patients, including, diagnosis, treatment and prognosis, for rheumatologists, general physicians, allied-specialists (dermatology, ophthalmology and gastroenterology), and other allied-professionals, such as physiotherapists. This version replaces the previous guidelines published on May 26, 2013 [3] and should be updated every 4 years. Methods A systematic literature review was performed, with external review of an specialized group of the Brazilian

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“…The majority of individuals with LTBIs remain asymptomatic during their lifetime, although 5%‐10% of them are at risk of TB reactivation . This is why an individual with LTBI is regarded as a potential reservoir of Mtb …”

Section: Introductionmentioning

confidence: 99%

First assessment of interferon gamma release assay results among healthcare workers at a general hospital in China

Guo

Jiang

Liu

et al. 2018

Clinical Respiratory J

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Introduction China has a very high tuberculosis (TB) burden. The interferon‐gamma release assay (IGRA) is more specific for the diagnosis of latent tuberculosis infection (LTBI) than the tuberculin skin test, especially among populations with a high degree of coverage by the BCG vaccine. Objectives To evaluate the first screening of healthcare workers (HCW) for LTBI using the IGRA at a general hospital in Beijing. Methods A pilot screening program for LTBI was triggered by accidental contact between HCW and two patients with active TB in the emergency department (ED). Given the necessity of estimating the overall LTBI prevalence in the institution, a sample of 518 HCW was enrolled in our cross‐sectional study. The second IGRA was repeated with 43 of the 121 HCW in the ED after exposure to index TB cases. Data on putative risk factors were collected with a self‐administered questionnaire. Results The prevalence of LTBI in the targeted population was 21.8%. Differences in the prevalence of LTBI were significantly related to age, employment duration, and history of occupational exposure. A lack of childhood BCG vaccination was independently associated with the prevalence of LTBI (adjusted OR: 1.686, 95% CI: 1.045‐2.723, P = .0325). No new LTBI was diagnosed 12 weeks postexposure. No HCW adopted the preventive treatment for LTBI. Conclusions Considering the high morbidity of LTBI among HCW even in general hospitals, it is essential to formulate government policies and institutional operation protocols for the systematic screening, registration, and administration of prophylaxes for the control of LTBI.

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Follow‐up of 1887 patients receiving tumor necrosis‐alpha antagonists: Tuberculin skin test conversion and tuberculosis risk

Abstract: Despite the high proportion of isoniazid prophylaxis, the incidence of tuberculosis in our patients receiving TNF-α antagonist was higher than the literature. Adalimumab treatment, male sex and previous tuberculosis disease history were found as risk factors for tuberculosis.

Cited by 16 publications

References 27 publications

A population-based study of tuberculosis incidence among rheumatic disease patients under anti-TNF treatment

A population-based study of tuberculosis incidence among rheumatic disease patients under anti-TNF treatment

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis – 2019

First assessment of interferon gamma release assay results among healthcare workers at a general hospital in China

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