Continuation of Anti-TNF Therapy for Rheumatoid Arthritis in Patients with Active Tuberculosis Reactivated during Anti-TNF Medication is more Beneficial than its Cessation

Abstract

Objective: To evaluate the safety and efficacy of continuous anti-Tumor Necrosis Factor (TNF) therapy in rheumatoid arthritis (RA) patients with activated tuberculosis (TB) during anti-TNF therapy. Methods: We evaluated a total of 20 cases of RA with active TB, which were treated with TNF inhibitors including infliximab, adalimumab, and etanercept during TB therapy. Seven patients received re-administration of the same inhibitor after missing several administrations (Group A), while seven patients were treated on a continuous basis (Group B). Six RA patients who developed TB without pre-treatment with TNF biologics received infliximab or etanercept 0 to 10 months after initiation of the anti-TB treatment (Group C). During anti-TB therapy, we evaluated the influence of anti-TNF therapy on the disease activity of RA, paradoxical response, clinical symptoms related to TB, and the sputum culture positive period as the sputum culture conversion period. Results: Anti-TB medications were initiated after patients were diagnosed with TB in all groups. All tubercle bacilli were susceptible to the anti-TB drugs used. No TB exacerbation occurred, following the initiation of anti-TB therapy, in any of the patients and despite anti-TNF therapy. The sputum culture positive period, after initiation of anti-TB treatment, was not prolonged but shortened by anti-TNF therapy in Group B. Three patients in Group A developed a paradoxical response after cessation of anti-TNF biologics, whereas there were no paradoxical responses in Group B. Conclusion: Treatment with TNF inhibitors had beneficial effects on all RA patients with activated TB.