Cagatay T, et al. - This study was implemented to examine the features of patients who developed tuberculosis while receiving tumor necrosis factor-alpha (TNF-α) antagonists and the associated factors with tuberculosis. Findings reported a higher incidence of tuberculosis among study participants receiving TNF-α antagonist as compared with literature, despite the high proportion of isoniazid prophylaxis. Researchers observed that the following factors conferred risk for tuberculosis: adalimumab treatment, male sex, and previous tuberculosis disease history.

Methods

• Researchers recorded patient's demographics, tuberculin skin test (TST), isoniazid prophylaxis, type of TNF-α antagonist.
• They also assessed TST conversion (>5mm increase) for patients who had baseline and 1-year TST.

Results

• Overall, researchers analyzed files of 1887 patients who were receiving TNF-α antagonists between August2005 and June 2015.
• They noted that TST significantly increased at the end of 1 year (n=748 baseline:7.36±7.2mm vs. 1 year:9.52±7.5mm, p<0.001).
• At 1 year, positive TST was seen in one third of patients (31.2%) who had negative TST at baseline.
As per data, 22 patients (1.16%) developed tuberculosis and the annual incidence of tuberculosis was 423/100000 patient-year.
• Findings demonstrated that ankylosing spondylitis (n=8), inflammatory bovel diseases (n=7), and rheumatoid arthritis (n=4) were the TNF-α antagonist indications.
• Infliximab was administered in 10 (45.5%) patients, etanercept in 6 (27.3%), and adalimumab in 6 (27.3%).
• Notably, 19 (86.4%) patients were under isoniazid prophylaxis.
• Extrapulmonary tuberculosis was detected in 12 patients (54.5%; 4 lymph node, 3 pleura, 2 periton, 1 pericarditis, 1 intestinal, 1 joint) and atypical mycobacterium in 1 patient.
• Risk factors for active tuberculosis were: adalimumab treatment (9.5x increase), male sex (15.6x increase), and previous tuberculosis disease history (11.5x increase).
• Furthermore, no association was noted between conversion of TST and tuberculosis.