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Free Content Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis

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SETTING: A major concern surrounding the use of tumor necrosis factor-alpha (TNF-α) inhibitors is their potential to increase the risk of opportunistic infections, particularly tuberculosis (TB).

OBJECTIVE: To estimate the incidence of active TB in patients with rheumatic diseases receiving anti-TNF drug therapy and to evaluate the effectiveness of an anti-tuberculosis chemoprophylaxis regimen.

DESIGN: Retrospective study of the files of 613 patients with rheumatic diseases who had received anti-TNF agent (etanercept, infliximab and adalimumab) therapy from July 2000 to June 2004 at the Aristotle University of Thessaloniki, Greece. All patients had a tuberculin skin test (TST) and a postero-anterior chest radiograph (CXR) prior to anti-TNF therapy. When indicated (TST ≥10 mm and/or fibrotic lesions on CXR), treatment for latent TB was established (6 months isoniazid [INH] or 3 months INH and rifampicin [RMP]). Anti-TNF agent therapy was started again 2 months later.

RESULTS: Of 45 patients who fulfilled the criteria for chemoprophylaxis, only 36 were treated correctly. Eleven patients developed active TB 2–35 months after the beginning of anti-TNF therapy. Six patients developed pulmonary and five extra-pulmonary TB. Eight of these had received infliximab and three adalimumab.

CONCLUSION: The incidence of active TB in this study population was estimated at 449 cases per 100000 population annually. Anti-tuberculosis chemoprophylaxis was only of partial preventive success in these patients.
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Keywords: TNF; adalimumab; etanercept; infliximab; rheumatoid arthritis; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Pulmonary Clinic, Aristotle University of Thessaloniki, G Papanicolaou Hospital, Thessaloniki, Greece 2: Rheumatology Department, First Internal Medicine Clinic, Aristotle University of Thessaloniki, AHEPA (American Hellenic Educational Progressive Association) Hospital, Thessaloniki, Greece

Publication date: 2006-10-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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