Tuberculosis in Biologic-naïve Patients With Rheumatoid Arthritis: Risk Factors and Tuberculosis Characteristics

Abstract

Objective To investigate risk factors and characteristics of active tuberculosis (TB) in biologics-naïve rheumatoid arthritis (RA) patients. Methods Population-based case-control study using the Swedish Rheumatology Quality Register, the National Patient Register and the Tuberculosis Register to identify RA cases with active TB and matched RA controls without TB 2001-2014. Clinical data were obtained from medical records. TB risk was estimated as adjusted (adj) odds ratios (OR) with 95% confidence intervals (CI) using univariate and multivariable logistic regression analyses. Results After validation of diagnoses, the study included 31 RA cases with TB, and 122 matched RA controls. All except three cases had reactivation of latent TB. Pulmonary TB dominated (84%). Ever use of methotrexate was not associated with increased TB risk (adj OR 0.8; 95% CI 0.3-2.0), whereas ever treatment with leflunomide (adj OR 6.0; 95% CI 1.5-24.6), azathioprine (adj OR 3.8; 95% CI 1.1-13.8) and prednisolone (adj OR 2.4 (95% CI 1.0-5.9) was. There were no significant differences of maximum dose of prednisolone, treatment duration with prednisolone before TB, or cumulative dose of prednisolone the year before TB diagnosis between cases and controls. Obstructive pulmonary disease was associated with an increased TB risk (adj OR 3.9; 95% CI 1.4-10.7). Conclusion Several RA-associated factors may contribute to the increased TB risk in biologics-naïve RA patients, making risk of TB activation difficult to predict in the individual patient. To further decrease TB in RA patients, the results suggest that screening for latent TB should also be considered in biologics-naïve patients.

Risk of Reactivation of Latent Tuberculosis in Psoriasis Patients on Biologic Therapies: A Retrospective Cohort from a Tertiary Care Centre in Northern Italy

“…In the light of this emerging evidence, after an initial risk assessment using QTF, in the event of a positive result, anti-IL-23 or anti-IL-17 drugs are prescribed without starting prophylactic therapy, but patients are still referred and linked to infectious disease or pneumologist care and consultation. Indeed, as for other autoimmune disorders (46), there is controversial evidence (47)(48)(49)(50) and plausible biological explanations (51,52) of an increased risk of TB even in biologic-naïve patients with psoriasis., we do not endorse an abrupt cessation of TB screening before and during any type of biologics in psoriatic patients. Rather, we suggest preserving this strategy from a broader public health point of view, waiting for cost-effectiveness analysis and an in-depth assessment of TB vs prophylaxis risks in biologic-naïve patients, as well as in the trajectory of primary Mtb infections during blockade of IL-12, IL-23 and IL-17 pathways.…”

The safety of COVID‐19 vaccination in immunocompromised children and young adults with immune‐mediated inflammatory disease

“…Patients with immune-mediated inflammatory disease (IMID) are at increased risk for infection, likely related to both underlying immune dysregulation, as well as frequent need for immunosuppression to control disease. [1][2][3] Fortunately, vaccination has proven to be a crucial strategy to prevent or mitigate severity of disease for various infections in patients with IMID. In December 2020, the US Food and Drug Administration issued Emergency Use Authorization for Pfizer-BioNTech and Moderna vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic.…”

“…Patients with immune‐mediated inflammatory disease (IMID) are at increased risk for infection, likely related to both underlying immune dysregulation, as well as frequent need for immunosuppression to control disease 1–3 . Fortunately, vaccination has proven to be a crucial strategy to prevent or mitigate severity of disease for various infections in patients with IMID.…”

Tuberkulose im Erwachsenenalter

“…50 %) und schweren Verläufen [75]. Auch unter anderen immunsuppressiven Therapien kann das Risiko für die Entwicklung einer Tuberkulose erhöht sein [76]. Für die meisten immunsuppressiven Therapien gibt es hierzu nur Einzelfallbeschreibungen, aber keine belastbaren Daten.…”

“…Auch ist zu bedenken, dass sowohl durch die Grunderkrankung selbst als auch durch eine immunsupprimierende Therapie mit z. B. hochdosierten Glukokortikoiden das relative Risiko für eine Tuberkulosereaktivierung erhöht sein kann [76,309]. Bei anderen klassischen csDMARDs, ebenso wie auch hochdosierten Glukokortikoiden, kann sich aufgrund der vorliegenden Daten und kleinen Fallzahlen aber nicht für ein generelles Screening ausgesprochen werden.…”