Tuberculosis in Children with Rheumatic Diseases Treated with Biologic Disease-Modifying Anti-Rheumatic Drugs

Area of Science:

• Pediatric Rheumatology
• Infectious Diseases
• Pharmacovigilance

Background:

• Biologic disease-modifying antirheumatic drugs (DMARDs) are used for chronic rheumatic diseases in children.
• Immunosuppression from biologics increases infection risk, including tuberculosis (TB).
• Current data on TB incidence in pediatric rheumatology patients on biologics is insufficient.

Purpose of the Study:

• To determine the prevalence of tuberculosis (TB) in children with rheumatic disorders treated with biological agents.
• To review existing literature on TB infections in this vulnerable pediatric population.

Main Methods:

• A literature search was conducted on MEDLINE and SCOPUS for articles published between January 1, 2010, and October 1, 2019.
• Reviewed and collated published data on TB infections in children with rheumatic disorders on biologics.

Main Results:

• Published data on TB in pediatric rheumatology patients on biologics is scarce, even in high-burden TB regions.
• Tuberculosis cases were occasionally reported in developed countries, primarily from Turkey.
• Retrospective studies suggest minimal TB risk, but prospective studies have short observation periods; registries often prioritize treatment efficacy over adverse events.

Conclusions:

• There is a significant lack of comprehensive data regarding TB incidence in children with rheumatic diseases on biologic therapies.
• Existing screening strategies for latent TB and the role of BCG vaccination require further investigation.
• Establishment of long-term, prospective national registries in high TB prevalence countries is crucial for monitoring treatment efficacy, adverse events, and infections.