Source: Annual Congress 2006 - Clinical aspects of tuberculosis
Disease area: Respiratory infections

Abstract

Background: A major concern surrounding the use of TNF-α inhibitors is their potential to increase the risk of opportunistic infections, particularly tuberculosis (TB).
The aim of the study was to estimate the incidence of TB in patients with rheumatic diseases receiving anti-TNF drug therapy and to evaluate the effectiveness of an anti-TB chemoprophylaxis regimen.
Methods: Retrospective study of the files of 613 patients with rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Behcet‘s disease) who had received anti-TNF agent (etanercept, infliximab and adalimumab) therapy from 7/2000 to 6/2004 at the Aristotle University of Thessaloniki, Greece. All patients had a tuberculin skin test (TST) and a posteroanterior chest radiograph prior to anti-TNF therapy. When indicated (TST≥10mm and/or fibrotic lesions on chest radiograph) treatment for latent tuberculosis was established (6 months isoniazid or 3 months isoniazid and rifampin). Anti-TNF agent therapy was started 2 months later.
Results: Forty-five patients fulfilled the criteria for chemoprophylaxis but only thirty-six were treated properly. Eleven patients developed active TB, 2-35 months after the beginning of anti-TNF therapy. Seven of them had taken anti-TB chemoprophylaxis adequately. Six patients developed pulmonary and five extrapulmonary TB. Eight of them had received infliximab and three adalimumab.
Conclusion: The incidence of tuberculosis among the population of the study (613 patients) was estimated to be 449 cases/100,000/year. Anti-TB chemoprophylaxis had only a partial preventive success in these patients.

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Citations should be made in the following way:
L. Sichletidis, L. Settas, D. Spyratos, D. Chloros, D. Patakas (Thessaloniki, Greece). Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis. Eur Respir J 2006; 28: Suppl. 50, 817

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