Effectiveness of Screening in Patients with Rheumatic Disease on Biological Therapy and Risk of Active Tuberculosis

Abstract

Background: Treatment with biologic therapy has been associated with a high risk of reactivation of latent tuberculosis (TB). Aims and Objectives: The study aimed to access the effectiveness of TB screening recommendations before the initiation of biological therapy and identify the incidence of active TB among these patients. Materials and Methods: A hospital-based retrospective cohort study among rheumatic disease patients on biological therapy in two centers between January 2005 to December 2019 was performed. Data was collected through review of medical records. Results: A total of 365 patients were included over a period of 14 years. Majority had Rheumatoid arthritis (RA) (80%). The mean age was 47.54 (±14.2), 311 (85%) were females with a mean duration of disease 8.45 years (± 6.58). Hundred forty-nine (42.3%) were on steroids. Anti TNFs were prescribed in 213 (58.4%) patients, Non-Anti-TNFs 124 (36.6%) patients, and Jak inhibitors 18 (5%) patients. TB screening was done to all patients except 3 patients (data missing) before commencing biologics. Forty-four (12.1%) patients had latent TB at baseline and all received chemoprophylaxis with isoniazid before starting biologics. Four patients with active TB were identified (one with Behcet’s disease and three with RA). One patient had a reactivation of latent TB and 3 patients developed de novo TB. Two were on rituximab and one each on infliximab and adalimumab. Two cases had pulmonary TB and two others had extrapulmonary TB (pericarditis and brain abscess each). All four patients with active TB were treated with standard anti TB medications. Three had complete resolution of their TB and one died. Conculsion: Baseline screening has been effectively carried out in our cohort as per recommendations. Physicians should be vigilant for symptoms and signs of active TB as not only reactivation of latent TB can occur with patients on biologics but in addition de novo TB can occur specially in endemic areas. Funding: None