Rheumatology International

, Volume 36, Issue 12, pp 1719–1725 | Cite as

Re-initiation of biologics after the development of tuberculosis under anti-TNF therapy

  • Yesim Ozguler
  • Gulen Hatemi
  • Serdal Ugurlu
  • Emire Seyahi
  • Melike Melikoglu
  • Sermin Borekci
  • Ersan Atahan
  • Gul Ongen
  • Vedat Hamuryudan
Observational Research
First Online:
Received:
Accepted:

Abstract

The use of anti-TNF agents is associated with an increased risk of tuberculosis (TB) and anti-TNF agents are stopped when active TB develops. However, discontinuation of treatment can result in flare of the underlying disease. The charts of 22 patients who developed active TB among a cohort of 2754 patients using anti-TNF agents between 2001 and 2013 were reviewed retrospectively. Patients restarting biologics during further follow-up were identified. One patient with miliary TB died within 1 month. A biologic agent was restarted in 16 of the remaining 21 patients (76 %). The most frequently re-initiated biologic agent was etanercept (n = 6) followed by rituximab (n = 5) and interferon-alpha (n = 3). Biologic treatment was re-initiated during anti-TB treatment in four patients and after completing TB treatment in 12 patients. The median follow-up after restarting biologics was 53 (IQR: 40–75) months. TB re-occurred in one patient with Behçet’s syndrome, who initially received etanercept due to severe sight-threatening uveitis at the third month of anti-TB treatment followed by canakinumab 15 months later along with methotrexate, cyclosporine and corticosteroids. After a second course of 9 months TB therapy this patient is currently stable on interferon-alpha for 33 months. Restarting of anti-TNF agents and other biologic agents, even during TB treatment, seems to be possible among patients who had previously developed TB under anti-TNF treatment. However, the risk of re-development of TB infection mandates careful follow-up.

Keywords

Tumor necrosis factor inhibitors Mycobacterium tuberculosis Rheumatoid arthritis Ankylosing spondylitis Behçet’s syndrome 
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Notes

Funding

This study has no funding.

Compliance with ethical standards

Conflict of interest

Gulen Hatemi has research grants from MSD and Abbvie pharmaceuticals. Vedat Hamuryudan has received speaker honorarium from MSD, Abbvie, and Pfizer. The other authors have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Yesim Ozguler
    • 1
  • Gulen Hatemi
    • 1
  • Serdal Ugurlu
    • 1
  • Emire Seyahi
    • 1
  • Melike Melikoglu
    • 1
  • Sermin Borekci
    • 2
  • Ersan Atahan
    • 2
  • Gul Ongen
    • 2
  • Vedat Hamuryudan
    • 1
  1. 1.Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical FacultyIstanbul UniversityFatih, IstanbulTurkey
  2. 2.Department of Pulmonary Diseases, Cerrahpasa Medical FacultyIstanbul UniversityFatih, IstanbulTurkey

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