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Active Tuberculosis Incidence and Characteristics in Patients Treated with Tumor Necrosis Factor Antagonists

Eun Hye Lee1, Young Ae Kang1, Ah Young Leem1

  • 1Division of Pulmonology, Department of Internal Medicine, Institute of Chest Diseases, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Scientific Reports
|July 27, 2017
PubMed

Insights

Patients on tumor necrosis factor (TNF) antagonists face a significant risk of developing active tuberculosis (TB), even with negative initial screening for latent TB infection (LTBI). Continuous monitoring is crucial for managing this risk.

Area of Science:

  • Immunology
  • Infectious Diseases
  • Rheumatology

Background:

  • Tumor necrosis factor (TNF) antagonists are widely used for inflammatory conditions.
  • TNF antagonism can increase the risk of tuberculosis (TB) reactivation.
  • Baseline screening for latent tuberculosis infection (LTBI) is standard practice before initiating TNF antagonist therapy.

Purpose of the Study:

  • To determine the incidence and characteristics of active TB in patients receiving TNF antagonists.
  • To evaluate the impact of baseline latent tuberculosis infection (LTBI) status on active TB development.
  • To assess the risk of active TB in patients with negative LTBI screening.

Main Methods:

  • Retrospective study of 702 patients aged ≥20 years treated with TNF antagonists.
  • LTBI diagnosis using interferon-gamma release assay (IGRA) and/or tuberculin skin test (TST).
  • Analysis of active TB development in relation to baseline LTBI status.

Main Results:

  • Latent tuberculosis infection (LTBI) was diagnosed in 36.3% of patients.
  • Active TB developed in 5 patients with treated LTBI and 6 patients with negative baseline LTBI results.
  • Standardized TB incidence ratios were elevated in both LTBI and negative LTBI groups, indicating significant risk.

Conclusions:

  • Patients treated with TNF antagonists are at risk for active TB, irrespective of baseline LTBI screening results.
  • Clinicians must maintain a high index of suspicion for active TB in patients on TNF antagonists.
  • Regular monitoring and serial testing are recommended during long-term TNF antagonist therapy, especially in high TB burden areas.

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