Increased risk of tuberculosis in patients treated with antitumor necrosis factor alpha

  • Elbek O
  • Uyar M
  • AydIn N
 et al. 
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Abstract

Drugs which antagonize tumor necrosis factor alpha (TNF-$α$) are known to increase the risk of tuberculosis. We aimed to evaluate the risk of tuberculosis in patients treated with anti-TNF-$α$, in Turkey. Two hundred and forty patients receiving anti-TNF-$α$, from December 2005 to December 2007, were included in the study. All participants provided a history and underwent a physical examination, a chest X-ray, and a tuberculin skin test. Isoniazid treatment was initiated in those patients with a latent infection, and they were followed up at 2-month intervals. A Bacillus Calmette-Guerin (BCG) scar was present in 184 patients (77.6{%}). The mean tuberculin skin test induration of patients on admission was 10.7±7.0 mm. Male gender and the presence of a BCG scar were predictors of a higher tuberculin skin test result (P {}0.05). Of the 240 subjects, 229 (95.4{%}) received methotrexate or corticosteroid treatment prior to anti-TNF-$α$ therapy. Isoniazid treatment preceded anti-TNF-$α$ administration in 185 (77.1{%}) of the 240 patients. Two patients developed tuberculosis (incidence 833/100,000). There was no correlation between initial and 12-month tuberculin skin test results (P {>} 0.05). Tuberculin skin test conversion was detected in five subjects during the 12-month follow-up; however, none developed active tuberculosis. One patient developed a drug reaction secondary to etanercept, and another demonstrated hepatotoxicity due to isoniazid. This study shows that anti-TNF-$α$ therapy increases the risk of tuberculosis, despite treatment of latent infection. {©} Clinical Rheumatology 2008.

Author-supplied keywords

  • Mycobacterium tuberculosis
  • Turkey (republic)
  • adolescent
  • adult
  • aged
  • ankylosing spondylitis
  • article
  • ascites
  • bacterium culture
  • chloroquine
  • colchicine
  • corticosteroid
  • coughing
  • eosinophilia
  • etanercept
  • ethambutol
  • female
  • follow up
  • human
  • incidence
  • infliximab
  • isoniazid
  • juvenile rheumatoid arthritis
  • liver toxicity
  • lung disease
  • lung tuberculosis
  • major clinical study
  • male
  • methotrexate
  • nonhuman
  • peritonitis
  • physical examination
  • priority journal
  • psoriatic arthritis
  • pyrazinamide
  • rheumatoid arthritis
  • rifampicin
  • risk assessment
  • salazosulfapyridine
  • scar
  • systemic sclerosis
  • thorax radiography
  • tuberculin test
  • tuberculosis
  • tuberculous lymphadenitis
  • tumor necrosis factor alpha antibody

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Authors

  • O Elbek

  • M Uyar

  • N AydIn

  • S Börekçi

  • N Bayram

  • H Bayram

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