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Tuberculosis screening in pediatric patients receiving TNF-alpha inhibitor therapy

Manolya Acar1, Murat Sütçü1, Hacer Aktürk1

  • 1Division of Infectious Diseases, Department of Pediatrics, İstanbul University İstanbul Faculty of Medicine, Istanbul, Turkey.

The Turkish Journal of Pediatrics
|May 11, 2018
PubMed

Insights

Tumor necrosis factor-alpha inhibitors (TNFIs) increase tuberculosis (TB) risk. Pediatric patients on TNFIs require screening for TB before and during therapy to prevent active disease.

Area of Science:

  • Pediatric Rheumatology
  • Infectious Diseases
  • Immunology

Background:

  • Tumor necrosis factor-alpha inhibitors (TNFIs) are associated with an increased risk of tuberculosis (TB).
  • Proactive screening for latent tuberculosis infection (LTBI) is crucial in patients initiating TNFI therapy.

Purpose of the Study:

  • To evaluate TB emergence in pediatric patients undergoing TNFI therapy.
  • To assess the effectiveness of TB screening protocols in this population.

Main Methods:

  • Retrospective observational study of 73 pediatric patients receiving TNFI therapy for ≥6 months (Jan 2011-Jan 2016).
  • Data collected included demographics, clinical history, TNFI type (adalimumab, infliximab, etanercept), LTBI screening, and isoniazid (INH) prophylaxis.
  • Follow-up duration was a median of 18 months.

Main Results:

  • 16 patients (21.9%) had LTBI and received INH prophylaxis before TNFI.
  • During follow-up, 16 patients (21.9%) initiated INH treatment.
  • One patient (1.3%) developed active TB despite INH treatment; one patient (3.1%) experienced elevated liver transaminases while on INH.

Conclusions:

  • Pediatric patients considered for TNFI therapy necessitate comprehensive TB screening prior to and throughout treatment.
  • Early detection and management of LTBI can mitigate TB risk in this vulnerable group.
  • Ongoing monitoring is essential to identify potential adverse effects of INH prophylaxis.

Keywords:
TNF-alpha inhibitorscreeningtuberculosis

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