Risk of tuberculosis comparison in new users of antitumour necrosis factor‐α and with existing disease‐modifying antirheumatic drug therapy

Chan, M.‐J.; Wen, Yao-Ko; Huang, Yu-Ting; Chuang, Hung‐Yi; Tain, You‐Lin; Wang, Y.‐C. Lily; Hsu, Chien‐Ning

doi:10.1111/jcpt.12644

Cited by 12 publications

(11 citation statements)

References 32 publications

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“…On the other hand, analysis of the RR in gender subgroups showed significantly elevated risk only in men. This was consistent with a recent cohort study that reported being male as an independent risk factor for TB …”

Section: Resultssupporting

confidence: 93%

“…Age is a key demographic parameter that predisposes individuals to TB risk, a burden that increases with age . Moreover, age of ≥60 years was reported to be an independent risk factor for TB associated with anti‐TNF‐α treatment . Consistently, the mean age of TB‐incident cases in key anti‐TNF‐α registries was reported to range from 53.1 to 70.2 which were higher than that (41.9) in our study and a previous multicentre study from Turkey (43.6) .…”

Section: Resultssupporting

confidence: 88%

“…32 Moreover, age of ≥60 years was reported to be an independent risk factor for TB associated with anti-TNF-α treatment. 33 Consistently, the mean age of TB-incident cases in key anti-TNF-α registries was reported to range from 53.1 to 70.2 8,9,11,31 which were higher than that (41.9) in our study and a previous multicentre study from Turkey (43.6). 23 In fact, while the mean age was higher in anti-TNF-α-naïve arm, it did not differ among patients who did or did not develop TB within each group, suggesting no effect of age on TB risk in our cohort.…”

Section: Discussionsupporting

confidence: 87%

“…This was consistent with a recent cohort study that reported being male as an independent risk factor for TB. 33 While current recommendations endorsed TB screening before any anti-TNF-α therapy irrespective of the indication, 14 attributed…”

Section: Discussionmentioning

confidence: 99%

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Relative risk of tuberculosis in patients with rheumatic diseases managed with anti-tumour necrosis factor-alpha therapy: A nationwide cohort study

et al. 2019

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Summary What is known and objective Anti‐tumour necrosis factor‐alpha (anti‐TNF‐α) therapy is known to raise the risk of granulomatous infections, leading to development of risk management strategies at national or global level. This study aimed to determine the relative risk (RR) of tuberculosis (TB) due to anti‐TNF‐α usage in patients with rheumatologic diseases (RDs) in a nationwide basis. Method This retrospective cohort study included patients with rheumatoid arthritis (RA), ankylosing spondylitis, juvenile idiopathic arthritis or psoriatic arthritis (PsA) that treated with or without anti‐TNF‐α agents, as registered in the national prescription information system between years 2013 and 2015. Two‐year RR of TB after anti‐TNF‐α therapy initiation was calculated in this RD population, including main subgroups. Results and discussion The study cohort included 413 500 RD patients, where anti‐TNF‐α(+) arm (n = 2117) had mean age of 41.9 ± 13.4 years and male distribution of 54.3%. Four patients among anti‐TNF‐α users developed TB compared to 128 patients in anti‐TNF‐α‐naïve group (189 vs 31 cases per 100 000 patients, respectively), yielding a 2‐year RR of 6.07 (95% CI, 2.25‐16.42) with an attributable risk of 0.16%. These RRs (95% CI), which were particularly pronounced, were 5.39 (1.69‐7.17) in men, 6.12 (2.26‐16.55) in adults, and 5.70 (1.41‐23.08) in RA and 13.46 (1.58‐114.40) in PsA patients. There was no difference between the anti‐TNF‐α users who developed and undeveloped TB regarding drug utilization characteristics, except significantly less immunosuppressive drug exposure in TB patients. What is new and conclusion This study is the first prescription‐based nationwide study to suggest an elevated RR of TB in a comparably younger population with a broad spectrum of RDs managed with any approved anti‐TNF‐α drug in Turkey.

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Section: Resultssupporting

confidence: 93%

Section: Resultssupporting

confidence: 88%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Relative risk of tuberculosis in patients with rheumatic diseases managed with anti-tumour necrosis factor-alpha therapy: A nationwide cohort study

et al. 2019

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“…77 Daha sonra 2005 yılında İsveç'te yayımlanan başka bir kayıt çalışmasında TNFalfa inhibitörü ile tedavi edilen RA hastalarında TB riskinin 4 kat arttığı bildirilmiştir. 65 Bunun ardından TNFalfa inhibitörü kullanımına dair TB risk artışı farklı ülkelerdeki birçok kayıt çalışmasıyla doğrulanmış, [78][79][80][81][82][83][84][85][86][87] çeşitli meta-analizlerle de desteklenmiştir. 66,88 Bu nedenle TNF-alfa inhibitörü alması planlanan hastalarda TB riskinin taranması ve riske ilişkin koruyucu önlemler alınmasına yönelik uzlaşı raporları veya kılavuzlar da yayımlanmıştır.…”

Section: Tnf-alfa Inhibitörleri Ve Tüberkülozunclassified

TNF-alpha inhibitor-induced infections in rheumatic diseases

Akıcı¹,

Aydin²

2018

tjtfp

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Alıntı Kodu: Aydın V., Akıcı A. Romatolojik hastalıklarda TNF-alfa inhibitörü kullanımına bağlı enfeksiyonlar. Jour Turk Fam Phy 2018; 09 (1): 13-24. Doi: 10.15511/tjtfp.18.00113. 13Özet 20 yılı aşkın bir süredir otoimmün hastalıklarda başarıyla kullanılan tümör nekrozis faktör (TNF) alfa (TNF-alfa) inhibitörleri tedavi protokollerinde önemli değişikliklere yol açmıştır. Romatoid artrit ve ankilozan spondilit gibi kronik otoimmün artritli hastalar TNF-alfa inhibitörü odaklı tedavilerden önemli ölçüde yarar sağlamıştır. Bununla birlikte, söz konusu ilaçların başta tüberküloz olmak üzere ciddi enfeksiyonlara yatkınlık yarattıkları ulusal ve uluslararası kayıt çalışmaları ve meta-analizlerle de gösterilmiştir. Bu riskin ilgili uzmanlık alanlarının yanı sıra birinci basamakta da farkında olunması, riskin başarıyla yönetilmesinde kilit önem taşır. Bu bakımdan TNF-alfa inhibitörlerini kullanmış/kullanmakta olan hastaların taşıdığı olası riskin tespiti ve yönetilmesi konularında birinci basamak hekimlerinin aktif rol alması beklenir. SummaryTumor necrosis factor (TNF)-alpha inhibitors have been successfully used in the management of autoimmune diseases for more than 20 years, causing a major paradigm shift in treatment protocols. Patients with chronic autoimmune arthritis such as rheumatoid arthritis or ankylosing spondylitis have gained substantial benefits from TNF-alpha inhibitor-based therapies. However, they also create a predisposition to serious infections, especially tuberculosis, as reported by national and international registries and meta-analyses. Apart from related specialty areas, the awareness of this risk in primary care is vital for improved management of the risk. Therefore, primary care physicians are expected to play an active role for the detection and management of the risk in patient treated with TNFalpha inhibitors.

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Infections in Biological and Targeted Synthetic Drug Use in Rheumatoid Arthritis: Where do We Stand? A Scoping Review and Meta-analysis

et al. 2023

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Introduction The advent of biological and targeted synthetic therapies has revolutionized rheumatoid arthritis (RA) treatment. However, this has come at the price of an increased risk of infections. The aim of this study was to present an integrated overview of both serious and non-serious infections, and to identify potential predictors of infection risk in RA patients using biological or targeted synthetic drugs. Methods We systematically reviewed available literature from PubMed and Cochrane and performed multivariate meta-analysis with meta-regression on the reported infections. Randomized controlled trials and prospective and retrospective observational studies including patient registry studies were analyzed, combined as well as separately. We excluded studies focusing on viral infections only. Results Infections were not reported in a standardized manner. Meta-analysis showed significant heterogeneity that persisted after forming subgroups by study design and follow-up duration. Overall, the pooled proportions of patients experiencing an infection during a study were 0.30 (95% CI, 0.28–0.33) and 0.03 (95% CI, 0.028–0.035) for any kind of infections or serious infections only, respectively. We found no potential predictors that were consistent across all study subgroups. Conclusions The high heterogeneity and the inconsistency of potential predictors between studies show that we do not yet have a complete picture of infection risk in RA patients using biological or targeted synthetic drugs. Besides, we found non-serious infections outnumbered serious infections by a factor 10:1, but only a few studies have focused on their occurrence. Future studies should apply a uniform method of infectious adverse event reporting and also focus on non-serious infections and their impact on treatment decisions and quality of life. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-023-00571-z.

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Risk of tuberculosis comparison in new users of antitumour necrosis factor‐α and with existing disease‐modifying antirheumatic drug therapy

Abstract: Anti-TNF-α therapy was independently associated with increased risk of TB in patients with mild disease, but it was not significantly correlated in patients with severe disease after adjusting for confounders.

Cited by 12 publications

References 32 publications

Relative risk of tuberculosis in patients with rheumatic diseases managed with anti-tumour necrosis factor-alpha therapy: A nationwide cohort study

Relative risk of tuberculosis in patients with rheumatic diseases managed with anti-tumour necrosis factor-alpha therapy: A nationwide cohort study

TNF-alpha inhibitor-induced infections in rheumatic diseases

Infections in Biological and Targeted Synthetic Drug Use in Rheumatoid Arthritis: Where do We Stand? A Scoping Review and Meta-analysis

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