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Intermediate to long-term follow-up results of INH chemoprophylaxis prior to anti-TNF-alpha therapy in a high-risk area for tuberculosis

Mittel- bis Langzeit-Follow-up Ergebnisse einer Chemoprophylaxe mit INH vor einer Therapie mit anti-TNF alpha in einem Hochrisikogebiet für Tuberkulose

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Summary

Background

The use of anti-TNF drugs for rheumatic diseases has increased in recent years. Several studies have reported an increased risk of reactivation of tuberculosis (TB) with anti-TNF agents.

Objectives

The aim of this study was to present the follow-up results of a single center from Turkey, a country with a high rate of active and latent tuberculosis infection (LTBI), for INH chemoprophylaxis in patients receiving anti-TNF-α therapy for rheumatic diseases infection.

Methods

In this prospective observational study, consenting patients who were to be administered an anti-TNF agent for a rheumatic disease were evaluated for the presence of active infection or LTBI by a chest X-ray and a tuberculin skin test. Patients with LTBI were given chemoprophylaxis 1 month prior to commencement of anti-TNF treatment. All patients were followed-up bimonthly for any signs of pulmonary or extrapulmonary TB.

Results

A total of 73 patients, 23 female (31.5 %) and 50 male (68.5 %), with a mean age of 41.0 ± 13.1 years (18–78) were enrolled in the study. Overall, 44 patients (60.3 %) had ankylosing spondylitis, 18 (24.7 %) had rheumatoid arthritis, 7 (9.6 %) had juvenile rheumatoid arthritis, and 3 (4.1 %) had psoriatic arthritis. LTBI was identified in 58 patients all of whom received chemoprophylaxis for 9 months. None of the patients in the study developed any signs of tuberculosis reactivation during follow-up.

Conclusions

TST is a reliable and cost-effective method for the diagnosis of LTBI in patients prior to anti-TNF therapy. Moreover, chemoprophylaxis with INH seems to be effective for the prevention of TB reactivation in individuals with LTBI.

Zusammenfassung

Grundlagen

Der Einsatz von anti-TNF Medikamenten in der Behandlung von rheumatischen Erkrankungen ist in den letzten Jahren gestiegen. Einige Studien haben ein erhöhtes Risiko einer Reaktivierung einer Tuberkulose (Tb) im Zusammenhang mit anti TNF Medikamenten beschrieben.

Ziel der Studie

Darstellung der Follow-up Ergebnisse einer INH Prophylaxe bei Patienten, die wegen einer rheumatischen Erkrankung eine anti-TNF Therapie erhalten, aus einem einzelnen Zentrum in der Türkei, einem Land mit einer hohen Rate an aktiver und latenter Tb-Infektion.

Methodik

In dieser prospektiven Beobachtungsstudie wurden Patienten, bei denen eine anti-TNF Therapie begonnen werden sollte, nach ihrer Einwilligung auf das Vorliegen einer aktiven oder latenten TB Infektion durch ein Lungen-Röntgen und einen Tuberkulin Hauttest (TST) untersucht. Patienten mit einer latenten Infektion wurde eine Chemoprophylaxe 1 Monat vor Beginn der anti-TNF Behandlung verabreicht. Alle Patienten wurden alle zwei Monate auf mögliche Zeichen eines pulmonalen oder extrapulmonalen Auftretens einer Tb untersucht.

Ergebnisse

Insgesamt wurden 73 Patienten, 23 Frauen (31,5 %) und 50 Männer (68,5 %), mit einem mittleren Alter von 41,0 ± 13,1 Jahren (18–78) in die Studie aufgenommen. 44 Patienten (60,3 %) hatten eine ankylosierende Spondylitis, 18 (24,7 %) eine rheumatoide Arthritis, 7 (9,6 %) eine juvenile rheumatoide Arthritis und 3 (4,1 %) eine Psoriasis Arthritis. Eine latente Tb Infektion wurde bei 58 Patienten festgestellt. Diese erhielten alle eine neun Monate anhaltende Chemoprophylaxe. Bei keinem dieser Patienten trat während des gesamten Beobachtungszeitraums eine Reaktivierung der Tb auf.

Schlussfolgerungen

Der TST Hauttest ist eine verlässliche und kosteneffizientee Methode zur Diagnose einer Tb bei Patienten, denen eine anti-TNF Therapie bevorsteht. Außerdem scheint eine Chemoprophylaxe mit INH wirksam, eine Reaktivierung der Tb bei Patienten mit latenter Infektion verhindern zu können.

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Conflict of interest

The authors declare that there is no actual or potential conflicts of interest in relation to this article.

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Authors and Affiliations

  1. Department of Chest Diseases, Abant Izzet Baysal University Faculty of Medicine, 14280, Bolu, Turkey

    Ozlem Kar Kurt, Bahar Kurt MD, Fahrettin Talay MD & Tuncer Tug MD

  2. Department of Rheumatology, Hisar Intercontinental Hospital, Istanbul, Turkey

    Mehmet Soy MD

  3. Department of Rheumatology, Bakirkoy Dr.Sadi Konuk Training and Research Hospital, Istanbul, Turkey

    Cemal Bes MD

  4. Institute of Oncology, Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Mutlu Hayran MD

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  1. Ozlem Kar Kurt
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  2. Bahar Kurt MD
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  3. Fahrettin Talay MD
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  4. Tuncer Tug MD
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  5. Mehmet Soy MD
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  6. Cemal Bes MD
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Correspondence to Ozlem Kar Kurt.

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Kurt, O., Kurt, B., Talay, F. et al. Intermediate to long-term follow-up results of INH chemoprophylaxis prior to anti-TNF-alpha therapy in a high-risk area for tuberculosis. Wien Klin Wochenschr 125, 616–620 (2013). https://doi.org/10.1007/s00508-013-0417-0

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  • DOI: https://doi.org/10.1007/s00508-013-0417-0

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