Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose:
There is increased risk of tuberculosis in patients treated with TNF-I. ACR guidelines recommend annual screening for latent tuberculosis infection(LTBI) in RA patients with risk factors. Few studies in the United States (US) assess risk of sero-conversion to positive TB test in patients on TNF-I. Conversion rates have been found to low, 0.138/100 patient year.1 Studies in Greece and Argentina (TB incidence 4.4 and 24 per 100,000) show conversion rate of 30% and 9.4% respectively2,3. Incidence of TB in California (5.2/100,000) is twice the national rate of 2.8/100,000 cases, with some Southern California counties with incidence up to 7.1/100,000. This study aims to analyze screening practices at academic centers in Southern California and to assess sero-conversion in RA on TNF-I agents.
Methods:
Data was extracted from the electronic health record for 400 adult patients with RA (based on ICD 9 and 10 codes) across 3 academic centers from January 2010- 2017. Inclusion criteria were TNF-I use for ≥ 1 year and negative QuantiFERON Gold status prior to use. Tuberculin skin test was not used at these sites. Demographics, drug type, duration of use and QuantiFERON test results were collected. Risk factors (birth in or travel to endemic areas, incarceration, homelessness, congregate residency, known exposure to contacts with TB) were assessed. Subjects with exposure to anti-mycobacterial drugs or use of non-TNF-I biologics were excluded. Rates of re-screening, sero-conversion and its association with drug use and other factors were calculated.
Results:
A total of 203 subjects were identified. 106 (52.2%) subjects had been rescreened for LTBI at a median time of 28 months post drug initiation. LTBI was diagnosed in 10 (9.4%) of the rescreened subjects: 5 on infliximab, 2 on adalimumab and golimumab each, 1 on etanercept. Median drug intake duration prior to seroconversion was 31 months and none had known risk factors. Testing for association of TNF-I with LTBI showed that 50% of patients in sero-conversion group were on Infliximab vs 27% of those in the negative conversion group. Comparison of risk with ethnicity showed that patients in the sero-conversion group were more likely to be Hispanic (75%) than non-Hispanic whites (25%).
Conclusion:
LTBI development was seen in 9.4% of patients with lack of known risk factors or exposure. This seroconversion was considerably higher than previous US-based studies and more in line with results from endemic countries. We conclude that annual screening for LTBI on TNF-I should take into consideration local/state TB prevalence, ethnicity, drug type and duration of drug use. For our local population, annual screening should be strongly considered.
References:
- Raza SH, et al. Conversion Rate of Tuberculosis Screening Tests in Patients with Rheumatic Diseases While Receiving anti-TNFα Agents [abstract]. Arthritis Rheum. 2016; 68
- Hatzara C, et al. Frequent conversion of TB screening tests during TNF therapy in patients with Rheumatic diseases[abstract] 2012 ACR Annual Meeting
- Cerda OL, et al. Tuberculin conversion in patients with Autoimmune arthropathy Receiving Biologic Therapy[abstract] 2014 ACR Annual Meeting.
To cite this abstract in AMA style:
Goel N, Torralba K, Salto L, Downey C. Screening for Acquired Latent Tuberculosis in Patients with Rheumatoid Arthritis(RA) on Anti-Tnfα Therapy (TNF-I) in Southern California [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/screening-for-acquired-latent-tuberculosis-in-patients-with-rheumatoid-arthritisra-on-anti-tnf%ce%b1-therapy-tnf-i-in-southern-california/. Accessed .« Back to 2018 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/screening-for-acquired-latent-tuberculosis-in-patients-with-rheumatoid-arthritisra-on-anti-tnf%ce%b1-therapy-tnf-i-in-southern-california/