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

  • O. E
  • M. U
  • N. A
 et al. 
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Abstract

Drugs which antagonize tumor necrosis factor alpha (TNF-alpha) are known to increase the risk of tuberculosis. We aimed to evaluate the risk of tuberculosis in patients treated with anti-TNF-alpha, in Turkey. Two hundred and forty patients receiving anti-TNF-alpha, 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), while there was no significant effect of age on the tuberculin skin test (P >0.05). Of the 240 subjects, 229 (95.4%) received methotrexate or corticosteroid treatment prior to anti-TNF-alpha therapy. Isoniazid treatment preceded anti-TNF-alpha 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-alpha therapy increases the risk of tuberculosis, despite treatment of latent infection. © Clinical Rheumatology 2008.

Author-supplied keywords

  • *tuberculosis/di [Diagnosis]
  • *tuberculosis/dt [Drug Therapy]
  • *tuberculosis/si [Side Effect]
  • *tumor necrosis factor alpha antibody/ae [Adverse
  • *tumor necrosis factor alpha antibody/dt [Drug The
  • Mycobacterium tuberculosis
  • Turkey (republic)
  • adolescent
  • adult
  • aged
  • ankylosing spondylitis/dt [Drug Therapy]
  • article
  • ascites/si [Side Effect]
  • bacterium culture
  • chloroquine/dt [Drug Therapy]
  • colchicine/dt [Drug Therapy]
  • corticosteroid/dt [Drug Therapy]
  • coughing/si [Side Effect]
  • eosinophilia/si [Side Effect]
  • etanercept/ae [Adverse Drug Reaction]
  • etanercept/dt [Drug Therapy]
  • ethambutol/cb [Drug Combination]
  • ethambutol/dt [Drug Therapy]
  • female
  • follow up
  • human
  • incidence
  • infliximab/ae [Adverse Drug Reaction]
  • infliximab/dt [Drug Therapy]
  • isoniazid/ae [Adverse Drug Reaction]
  • isoniazid/cb [Drug Combination]
  • isoniazid/do [Drug Dose]
  • isoniazid/dt [Drug Therapy]
  • juvenile rheumatoid arthritis/dt [Drug Therapy]
  • liver toxicity/si [Side Effect]
  • lung disease/si [Side Effect]
  • lung tuberculosis/di [Diagnosis]
  • lung tuberculosis/dt [Drug Therapy]
  • lung tuberculosis/si [Side Effect]
  • major clinical study
  • male
  • methotrexate/dt [Drug Therapy]
  • nonhuman
  • peritonitis/di [Diagnosis]
  • peritonitis/dt [Drug Therapy]
  • peritonitis/si [Side Effect]
  • physical examination
  • priority journal
  • psoriatic arthritis/dt [Drug Therapy]
  • pyrazinamide/cb [Drug Combination]
  • pyrazinamide/dt [Drug Therapy]
  • rheumatoid arthritis/dt [Drug Therapy]
  • rifampicin/cb [Drug Combination]
  • rifampicin/dt [Drug Therapy]
  • risk assessment
  • salazosulfapyridine/dt [Drug Therapy]
  • scar
  • systemic sclerosis/dt [Drug Therapy]
  • thorax radiography
  • tuberculin test
  • tuberculous lymphadenitis/di [Diagnosis]
  • tuberculous lymphadenitis/dt [Drug Therapy]
  • tuberculous lymphadenitis/si [Side Effect]

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Authors

  • Elbek O.

  • Uyar M.

  • AydIn N.

  • Borekci S.

  • Bayram N.

  • Bayram H.

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