AB1276 SCREENING FOR LATENT TUBERCULOSIS INFECTION BEFORE BIOLOGICS IN ALGERIAN PATIENTS WITH RHEUMATIC DISEASES

Abstract

BackgroundThe use of biological agents has significantly improved the management of chronic rheumatic diseases (CRD). However, these treatments increase the risk of tuberculosis due to the reactivation of a previous latent tuberculosis infection (LTBI), making its diagnosis and treatment very important prior to initiating therapy.ObjectivesTo identify the prevalence of LTBI in Algerian patients with CRD before the initiation of biotherapy.MethodsWe conducted a multicenter, retrospective study over a period of 10 years including patients with CRD receiving biological therapy for at least 6 months. LTBI diagnosis was based on a positive tuberculin skin test (TST) or QuantiFERON-TB Gold In-Tube test (QFT-GIT) without clinical symptoms, and bacteriological and radiographic signs of disease.Results271 (154 men/117 women) were included, and the mean age of patients was 40.6± 12.9 years. The most common CRD was ankylosing spondylitis (57.9%) followed by rheumatoid arthritis (22.1%), psoriatic arthritis (12.2%), and spondyloarthritis associated with inflammatory bowel disease (4.8%). Patients received adalimumab in 117 (43.2%) cases, etanercept in 89 (32.8%) cases, infliximab in 40 (14.8%) cases, tocilizumab in 24 (8.9%) cases and anakinra in 1 case. Medical history of tuberculosis was noted in 3 cases and 4 patients have a history of household contact with tuberculosis. TST was performed in 186 cases and was positive in 13.2%. 261 patients underwent a QFT-GIT, which was positive in 16.9%. The diagnosis of active pulmonary tuberculosis was made in one patient who had positive TST and images of active tuberculosis in the chest X-ray. Quadruple therapy including rifampicin (10mg/kg/day), isoniazid (5mg/kg/day), pyrazinamide (25mg/kg/d) and ethambutol (15mg/kg/d) was prescribed for this patient. However, LTBI was diagnosed in 54 cases (19.9%), 29 had negative TST with positive QFT-GIT. 34 patients received a combination of rifampicin and isoniazid for three months and 20 received the isoniazid monotherapy for six months without developing active disease. Hepatotoxicity was observed in 5.6% of cases. The biological therapy was initiated 10.34±9.96 weeks after chemoprophylaxis, and 55.5% were treated with etanercept. After a follow-up of 23.5±15.7 months 4 cases of active tuberculosis infection were reported (2 lymph nodes, 1 pleural, and 1 intestinal tuberculosis) in patients with initially negative TST and QFT-GIT. One patient had TST conversion and received antibiotic prophylaxis.ConclusionOur study showed that the screening and chemoprophylaxis recommendations for LTBI improve the safety of biological treatments. However, because tuberculosis infection remains a potential complication, especially in endemic countries like Algeria, we suggest that annual screening of patients on biotherapy could reduce the risk of active tuberculosis.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.