Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis
Abstract: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.
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: October 1, 2006
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