Background/Purpose: Background: Current recommendations for latent tuberculosis infection (LTB) screening and treatment in patients eligible for anti-TNF agents are not well established in endemic regions. Thus, the aim of this study is to evaluate the long-term efficacy of LTB screening and treatment in RA patients under TNF blockers tight control therapeutic strategy

Methods: Two hundred and two RA patients (1987 criteria) eligible for anti-TNF agents were initially screened for LTB by PPD test, chest X-ray and history of contact. Two hundred and nine patients receiving traditional DMARDs comprised the control group. Patients and controls were regularly followed at 1-3 months interval, from January 2007 to December 2011. During the study period, PPD was repeated in patients with TB clinical suspicion or due to extended (>12 months) interruption/re-start of biologic treatment.

Results: 202 patients were treated with anti-TNF blockers, 85(42%) with one agent and 117(58%) with two or more: 181 received infliximab, 93 adalimumab and 75 etanercept. LTB screening (PPD and/or history of contact and/or X-ray) was positive in 69(34%) patients. In 65%(45 patients) PPD was positive, 36%(n=25) had history of contact and 21%(n=15) with X-ray alterations. Of note, in the 24 LTB patients with negative PPD, contact history accounted for 75% and X-ray for 37% of the positive screened cases. LTB treatment with isoniazid during 6 months was administered to all positive screened patients and none developed TB during follow-up. Regarding the 133 remaining screening negative patients none had TB during the first twelve months of anti-TNF therapy. PPD test was repeated in only 53 patients (26%) due to interruption/re-start of biologic treatment (51cases) or clinical TB suspicion (2 cases). PPD turned out to be positive in five patients: three that received LTB treatment and the two patients with clinical TB suspicion, both diagnosed as active TB (after 14 and 36 months of anti-TNF treatment) and properly treated with standard TB treatment. In those RA patients under traditional DMARDs, three cases (1.5%) of active TB were observed. Thus, the frequency of TB in RA patients during five years of observation was similar in patients under biological and traditional DMARDs (1% vs. 1.5%, p=0.68), although higher than the expected for the area (60/100,000/ per year).

Conclusion: The present study provided evidence that the recommended screening and treatment protocol for LTB in patients under anti-TNF treatment was also efficient in endemic areas, with a special attention to contact history in those with negative PPD. Active TB diagnosis during anti-TNF treatment seems not to be related to screening failure, reinforcing the importance of constant clinical surveillance.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/latent-tuberculosis-screening-and-treatment-in-rheumatoid-arthritis-patients-eligible-for-anti-tnf-therapy-in-endemic-areas-does-it-work/