Risk Of Tuberculosis In Patients Research Articles

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

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.

Zum Stellenwert der neuen In-vitro-Bluttests für das Tuberkulosescreening vor Gabe von TNF-α-Inhibitoren bei Psoriasis

Aufgrund des erhöhten Tuberkuloserisikos beim Einsatz von TNF-α-Inhibitoren bei der Behandlung der Psoriasis vulgaris bzw. der Psoriasisarthritis sollte bei allen Patienten eine aktive TB ausgeschlossen werden und ein Screening auf Vorliegen einer latenten TB (LTBI) vor TNF-α-Therapie erfolgen. Das Screening sollte eine Röntgen-Thorax-Aufnahme, eine sorgfältigen Anamnese und die Durchführung eines hochspezifischen Interferon-Gamma Release Assays (IGRA) umfassen. Da sowohl falsch positive als auch falsch negative Tuberkulinhauttest (THT)-Ergebnisse in diesen Patientengruppen erwartet werden können, wird der früher häufig durchgeführte THT nicht mehr empfohlen. Die Behandlung der LTBI bei positivem IGRA umfasst grundsätzlich eine Chemoprävention mit Isoniazid (INH) über 9 Monate.

Risk of tuberculosis in patients treated with tumor necrosis factor antagonists due to incomplete prevention of reactivation of latent infection

To evaluate the causes of new cases of active tuberculosis (ATB) in patients treated with tumor necrosis factor (TNF) antagonists included in the national registry BIOBADASER (Base de Datos de Productos Biológicos de la Sociedad Española de Reumatología) after the dissemination of recommendations to prevent reactivation of latent tuberculosis infection (LTBI). Incidence rate of ATB per 100,000 patient-years and 95% confidence intervals (95% CIs) were calculated in patients entering BIOBADASER after March 2002 and were stratified by compliance with recommendations (complete or incomplete). ATB rates in BIOBADASER were compared with the background rate and the rate in the rheumatoid arthritis cohort EMECAR (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide) not treated with TNF antagonists. In addition, rates of ATB among patients treated with adalimumab, etanercept, and infliximab were estimated and compared only for treatments started after September 2003, when all 3 drugs became fully available. Following March 2002, a total of 5,198 patients treated with a TNF antagonist were registered in BIOBADASER. Fifteen ATB cases were noted (rate 172 per 100,000 patient-years, 95% CI 103-285). Recommendations were fully followed in 2,655 treatments. The probability of developing ATB was 7 times higher when recommendations were not followed (incidence rate ratio 7.09, 95% CI 1.60-64.69). Two-step tuberculosis skin test for LTBI was the major failure in complying with recommendations. New cases of ATB still occur in patients treated with all available TNF antagonists due to lack of compliance with recommendations to prevent reactivation of LTBI. Continuous evaluation of recommendations is required to improve clinical practice.

Guidelines for Prevention of Tuberculosis in Patients with Rheumatoid Arthritis Treated with TNF-alpha Blockers

Introduction of tumor necrosis factor (TNF) inhibitor for the treatment of rheumatoid arthritis (RA) induces not only significant improvement of symptoms and signs of RA but also substantial inhibition of progressive joint damage. Such therapeutic efficacies of TNF inhibitor have led to a paradigm shift in the treatment of RA. In spite of its dramatic effect against RA, it is now well established that the use of TNF inhibitor significantly increases the risk of tuberculosis in patients with RA. Therefore some countries have presented guidelines in the use of TNF inhibitors for rheumatoid arthritis to reduce the risk of tuberculosis. Korea Food and Drug Association (KFDA) have also provided guidelines for treating latent tuberculosis when using TNF inhibitors. In this article, we reviewed the general epidemiology of tuberculosis and incidence rates of tuberculosis in RA patients and those of RA patients treated with TNF inhibitors. We also introduced methods for the diagnosis of latent tuberculosis, and various guidelines published in different countries in managing tuberculosis in RA patients who were to be treated with TNF inhibitors. Finally, we suggest requirement of more appropriate guidelines for Korean RA patients who are candidates for treatment with TNF-inhibitors.

The Risk of Tuberculosis in Patients with Cancer

Current US guidelines for the management of latent tuberculosis infection in cancer patients are based on studies from 1970s, yet much about cancer care has changed in the interim. In a review of our experience during the past 25 years, we found that incidence of tuberculosis varied significantly according to country of birth and cancer type. Foreign-born patients with underlying hematologic neoplasm had a tuberculosis rate 50-100 times higher than US-born patients, whereas US-born patients with an underlying solid tumor had the same tuberculosis rate as US-born persons without cancer. These findings may help guide the management of latent tuberculosis infection in persons with cancer.

Risk of tuberculosis in patients with HIV-I and HIV-II infections in Abidjan, Ivory Coast.

To examine the association between HIV-II infection and tuberculosis. Cross sectional study comparing the prevalence of HIV-I and HIV-II infections in patients with tuberculosis and in blood donors. Abidjan, Ivory Coast, west Africa. 2043 consecutive ambulant patients with tuberculosis (confirmed pulmonary, presumed pulmonary, or extrapulmonary) and 2127 volunteer blood donors. Prevalence of HIV-I and HIV-II infections as assessed by presence of serum antibodies. Overall rates of HIV infection were 40.2% in patients with tuberculosis (26.4% positive for HIV-I, 4.7% for HIV-II, and 9.0% for both); and 10.4% in blood donors (7.2% positive for HIV-I, 1.9% for HIV-II, and 1.3% for both). HIV-II infection was significantly more common in patients with all types of tuberculosis than in blood donors (97/2043, 4.7% v 40/2127, 1.9%; odds ratio 3.8%, 95% confidence interval 2.6 to 5.6). Both HIV-I and HIV-II infections are associated with tuberculosis in Abidjan. 35% of adult tuberculosis in Abidjan is attributable to HIV infection and 4% specifically to HIV-II.