The clinical respiratory journal 2017 10 13() doi 10.1111/crj.12726
To evaluate the characteristics of patients who developed tuberculosis while receiving tumor necrosis factor-alpha (TNF-α) antagonists and the related factors with tuberculosis.
Patient’s demographics, tuberculin skin test (TST), isoniazid prophylaxis, type of TNF-α antagonist were recorded. TST conversion (>5mm increase) was evaluated for patients who had baseline and 1-year TST.
Files of 1887 patients who were receiving TNF-α antagonists between August2005 and June 2015 were evaluated. TST significantly increased at the end of 1 year (n=748 baseline:7.36±7.2mm vs. 1 year:9.52±7.5mm, p<0.001). One third of patients (31.2%) who had negative TST at baseline, had positive TST at 1 year. Tuberculosis developed in 22 patients (1.16%). The annual incidence of tuberculosis was 423/100000 patient-year. TNF-α antagonist indications were ankylosing spondylitis (n=8), inflammatory bovel diseases (n=7), and rheumatoid arthritis (n=4). Ten (45.5%) patients received infliximab, 6 (27.3%) etanercept, and 6 (27.3%) received adalimumab. Nineteen (86.4%) patients were under isoniazid prophylaxis. Twelve patients had extrapulmonary tuberculosis (54.5%; 4 lymph node, 3 pleura, 2 periton, 1 pericarditis, 1 intestinal, 1 joint). Atypical mycobacterium was detected in one patient. Adalimumab treatment (9.5x increase), male sex (15.6x increase), and previous tuberculosis disease history (11.5x increase) were risk factors for active tuberculosis. Conversion of TST was not found related with tuberculosis. CONCLUSIONS
Despite the high proportion of isoniazid prophylaxis, the incidence of tuberculosis in our patients receiving TNF-α antagonist was higher than the literature. Adalimumab treatment, male sex, and previous tuberculosis disease history were found as risk factors for tuberculosis. This article is protected by copyright. All rights reserved.