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Characteristics Predicting Tuberculosis Risk under Tumor Necrosis Factor-α Inhibitors: Report from a Large
Bunyamin Kisacik1, Omer Nuri Pamuk1, Ahmet Mesut Onat1
1From the Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gaziantep University, Gaziantep; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Trakya University, Edirne; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Istanbul University; Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University; Division of Rheumatology, Department of Internal Medicine, Fatih Sultan Mehmet Research and Training Hospital; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Marmara University, Istanbul; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Uludag University, Bursa; Division of Rheumatology, Department of Internal Medicine, Hacettepe University Hospital; Division of Rheumatology, Department of Internal Medicine, Gulhane Military School of Medicine; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Pamukkale University, Ankara; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Ege University; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Katip Celebi University, Izmir; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Sutcu Imam University, Kahramanmaras; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Mayis University, Samsun; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Kocaeli University, Izmit; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Akdeniz University, Antalya; Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey.B. Kisacik, MD, Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Gaziantep University; O.N. Pamuk, MD, Division of Rheumatology, Department of Int
Objective:
Screening strategies for latent tuberculosis (TB) before starting tumor necrosis factor (TNF)-α inhibitors have decreased the prevalence of TB among patients who are treated with these agents. However, despite vigilant screening, TB continues to be an important problem, especially in parts of the world with a high background TB prevalence. The aim of this study was to determine the factors related to TB among a large multicenter cohort of patients who were treated with anti-TNF.
Methods:
Fifteen rheumatology centers participated in this study. Among the 10,434 patients who were treated with anti-TNF between September 2002 and September 2012, 73 (0.69%) had developed TB. We described the demographic features and disease characteristics of these 73 patients and compared them to 7695 patients who were treated with anti-TNF, did not develop TB, and had complete data available.
Results:
Among the 73 patients diagnosed with TB (39 men, 34 women, mean age 43.6 ± 13 yrs), the most frequent diagnoses were ankylosing spondylitis (n = 38) and rheumatoid arthritis (n = 25). More than half of the patients had extrapulmonary TB (39/73, 53%). Six patients died (8.2%). In the logistic regression model, types of anti-TNF drugs [infliximab (IFX), OR 3.4, 95% CI 1.88-6.10, p = 0.001] and insufficient and irregular isoniazid use (< 9 mos; OR 3.15, 95% CI 1.43-6.9, p = 0.004) were independent predictors of TB development.
Conclusion:
Our results suggest that TB is an important complication of anti-TNF therapies in Turkey. TB chemoprophylaxis less than 9 months and the use of IFX therapy were independent risk factors for TB development.
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