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Risk of tuberculosis in children with rheumatologic diseases treated with biological agents: A cross-sectional cohort

Nuri Bayram1, Özge Altuğ Gücenmez2, Balahan Makay2

  • 1Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Türkiye.

Archives of Rheumatology
|December 21, 2023
PubMed

Insights

Children on biologic therapies for rheumatologic diseases showed no increased risk of tuberculosis (TB). Combined screening with tuberculin skin test (TST) and interferon-gamma release assay (IGRA) is effective for TB detection in these patients.

Area of Science:

  • Pediatric Rheumatology
  • Infectious Disease Control
  • Immunology

Background:

  • Biologic agents are increasingly used for pediatric rheumatologic diseases.
  • Tuberculosis (TB) risk is a concern in patients on immunosuppressive therapies, especially in high-burden countries.
  • Effective screening strategies are crucial to prevent TB reactivation or new infection.

Purpose of the Study:

  • To assess the risk of developing TB disease in children treated with biologic agents for rheumatologic conditions.
  • To evaluate the utility of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) for TB screening in this pediatric population.
  • To determine appropriate TB screening protocols in a high-priority TB endemic region.

Main Methods:

  • Retrospective study of 109 children receiving biologic agents for rheumatologic diseases for over two years.
  • TB screening using TST and/or IGRA at baseline and regular intervals during follow-up.
  • Clinical monitoring for TB symptoms every three months and via TST/IGRA every 12 months.

Main Results:

  • No cases of active TB disease were observed during the follow-up period (average 3.6 years).
  • Concomitant use of TST and IGRA identified discrepancies, with IGRA positive in 14.1% and TST positive in 7.3% of initially negative patients.
  • Six of nine IGRA-positive patients had negative baseline TST, highlighting the value of combined testing.

Conclusions:

  • Biologic therapy in closely monitored children with rheumatologic diseases was not associated with an increased risk of TB disease.
  • Combined TST and IGRA screening is a reasonable approach for TB detection in pediatric patients undergoing biologic treatment.
  • This strategy aids in safe initiation and continuation of immunosuppressive therapies in high-risk populations.
Abstract

Keywords:
Biological agentschildreninterferon-gamma release assayscreeningtuberculin skin test.

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