Tuberculosis Frequency in Patients Taking TNF-alpha Blokers

Abstract

Objective: To evaluate tuberculosis frequency in patients who take tumor necrosis factor alpha (TNF-a) inhibitors for Collagen Vascular Disease (CVD). Materials and Methods:Patients who actively use or were planned to use TNF-a inhibitors for CVD between June 2007-February 2010 were prospectively included in the study.All patients had a physical examination, chest x-ray and the Tuberculin Skin Test (TST). Sputum smear and culture for acid fast bacilli (AFB) was performed in patients with a suspicious lesion on chest x-ray. During follow-up, physical examination, chest x-ray and sputum smear for AFB in indicated cases were performed every 3 months. Tuberculosis was diagnosed with microbiological, radiological and histopathological methods.In case of pulmonary or extrapulmonary tuberculosis,TNF-a inhibitor medication was stopped and anti-tuberculosis therapy was began.Results: A total of 179 patients were included in the study, 91 were female and 88 were male wth a mean age of 42.8±12.0. In 141 patients, TNF-a inhibitor therapy was begun in the study although 38 were taking TNF-a inhibitor medication at the beginning of the study. The median follow-up period was 17 months and 2 (1.1%) patients were diagnosed to have active tuberculosis during the study period. The TST was found to be 5-9 mm in 15% and >10 mm in 53.3% of the patients.There was a successful tuberculosis therapy history in 5 patients and at least 1 BCG scar was seen in 67 patients.In our series, 70.9% of the patients had chemoprophylaxis during the study period and new tuberculosis was diagnosed in 2 patients, consisting of one miliary tuberculosis and one pleural tuberculosis. Tuberculosis was diagnosed in 1.1% of TNF-alpha taking patients in our series. Conclusion: It is recomended that the patients taking anti TNF treatment should be evaluated and followed up regularly for tuberculosis during the treatment. (Turk Toraks Derg 2012; 13: 93-8) ÖZET Amaç: Kollojen doku hastalığı (KDH) nedeniyle anti tümör nekrozis faktör alfa (TNF-a) tedavisi alan hastalarda tüberküloz (Tb) sıklığını araştırmak. Gereç ve Yöntem: Temmuz 2007-Şubat 2010 tarihleri arasında KDH tanısı ile anti-TNF-a tedavisi alan veya anti-TNF-a tedavisi planlanan hastalar prospektif olarak çalışmaya dahil edildi. Tüm hastalarda çalışmanın başlangıcında fizik muayenenin ardından, posterio-anterior (PA) akciğer grafisi, tüberkülin deri testi (TDT) yapıldı. Akciğer grafilerinde lezyon olan hastalarda balgamda asidorezistan basil (ARB) direkt ve kültür yöntemleriyle bakıldı.Anti-TNF-a tedavisi sürecinde hastalar 3 aylık aralıklarla fizik muayene, akciğer grafisi ve endike olgularda balgam ARB tetkikleri ile takip edildi. Tüberküloz tanısı radyolojik, mikrobiyolojik ve histopatolojik yöntemlerle konuldu. Pulmoner ya da extrapulmoner tüberküloz varlığında TNF-a tedavisi kesilerek anti-tüberküloz tedavi başlandı. Bulgular: Çalışmaya dahil edilen 179 hastanın 91'i kadın, 88'i erkek olup yaş ortalaması 42.8±12 olarak hesaplandı. Hastaların 141'ine anti TNF-a tedavisi başlanması planlanırken, 38'si...

Factors Affecting the Tuberculosis Risk in Patients Receiving Anti-Tumor Necrosis Factor-α Treatment

“…In another report from Japan, TB was found to develop in 13 out of 4,000 patients receiving these agents [30]. In contrast, there is a relative scarcity of data on the prevalence of TB in patients receiving aTNF-α-T in Turkey [5,19,20,21,22]. Hanta et al [20] reported 3 patients developing TB out of 192 who received aTNF-α-T. Elbek et al [5] concluded that aTNF-α-T is associated with a nearly 40-fold increased risk of TB after observing active TB in 2 of 240 subjects during the course of aTNF-α-T.…”

“…On the other hand, limited data from this country regarding the incidence of TB in patients undergoing aTNF-α-T suggests an 11-40 times higher risk of TB compared to the general population [5,19,20,21,22]. …”

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

“…In fact, with a background of serious TB epidemic experience during the first half of the 20th century, the country showed around 2‐fold diminishing TB incidence trend over last 25 years with a resultant incidence rate of 18/100 000 in an about 79 millions of population in 2016, but still considered among high‐priority countries by WHO . However, several studies reported substantial elevation of TB incidence associated with anti‐TNF‐α agents despite the presence of a risk management strategy . This requires evaluation of the TB risk at the national level that would not only reflect the relative risk (RR) but also help to address potential areas of development or contributions to existing risk management strategy.…”

“…18,19 However, several studies reported substantial elevation of TB incidence associated with anti-TNF-α agents despite the presence of a risk management strategy. [20][21][22][23][24] This requires evaluation of the TB risk at the national level that would not only reflect the relative risk (RR) but also help to address potential areas of development or contributions to existing risk management strategy.…”

“…Demographic and clinical characteristics of the study arms studies that reported a 4-fold RR of TB associated with anti-TNF-α agents 30. Previous Turkish cross-sectional and case-control studies with a duration of 2-10 years before 2013 showed comparably higher incidences of TB among anti-TNF-α users [20][21][22][23][24]. While this at first sight might be explained by the smaller sample size and comparably higher incidence of TB in Turkey about 10 years ago, 21 possible under-recognition of TB screening protocol that was relatively newly proposed at that time16 could be more attributable, indicating relative success of available risk management strategy.…”