Active Tuberculosis Risk With Tumor Necrosis Factor Inhibitors After Treating Latent Tuberculosis -a 7-Year Retrospective Observational Study

Minkyung Kwon¹, Mindong Sung¹, Yong-Jin Kwon¹, Young Goo Song¹, Sang-Won Lee², Min-Chan Park¹, Yong-Beom Park¹, Soo-Kon Lee¹ and Jason Jungsik Song¹, ¹Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea, ²Department of Internal Medicine, Yonsei University College of Medicine, Seoul, NV, South Korea

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: anti-TNF therapy, rheumatic disease and tuberculosis

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects II: Predictors of Disease Course in Rheumatoid Arthritis - Treatment Approaches

Session Type: Abstract Submissions (ACR)

Background/Purpose: Active tuberculosis (TB) risk increases during anti-tumor necrosis factor (TNF) therapy and latent TB infection (LTBI) screening is recommended in potential TNF inhibitor users. It is unclear whether anti-TNF therapy elevates active TB risk even after LTBI treatment. We sought to evaluate the risk of active TB development in LTBI-positive TNF inhibitor users following the current treatment guidelines for LTBI in South Korea, TB prevalent area.

Methods: We retrospectively studied 949 TNF inhibitor users with immune-mediated inflammatory diseases at Yonsei University Health System from 2005-2012. Long-term TNF inhibitor users who followed current national guidelines for LTBI were enrolled for analysis. We compared the incidence rate of active TB among LTBI-positive TNF inhibitor users (n=256) and LTBI-negative TNF inhibitor users (n=521) using Poisson regression.

Results: There were 256 LTBI-positive and 521 LTBI-negative TNF inhibitor users. Six LTBI-positive and five LTBI-negative TNF inhibitor users developed active TB during the 7.8-year study duration. To adjust for different TNF inhibitor exposure durations among patients, we calculated patient-years (PY) exposure rates. Active TB incidence rate was 1107 per 100,000 PY in LTBI-positive TNF inhibitor users and 490 per 100,000 PY in LTBI-negative TNF inhibitor users. Active TB risk was not elevated in LTBI-positive versus LTBI-negative TNF inhibitor users (sex- and age-adjusted incidence rate ratio, 2.2; 95% CI 0.6–7.7). The median onset of active TB in LTBI-positive TNF inhibitor users was 8.6 months (range 3.9-22.4 months) and 14.6 months in LTBI-negative TNF inhibitor users (range 9.6-18.1 months) Among the 11 TNF inhibitor users who developed active TB, 50% of LTBI-positive TNF inhibitor users (three patients) developed active TB within 9 months while they were on isoniazid, whereas no LTBI-negative TNF inhibitor users developed active TB in the same period.

Conclusion: Risk of developing active TB in LTBI-positive TNF inhibitor users is not significantly higher than in LTBI-negative TNF inhibitor users, after receiving LTBI treatment.

Disclosure:

M. Kwon,
None;

M. Sung,
None;

Y. J. Kwon,
None;

Y. G. Song,
None;

S. W. Lee,
None;

M. C. Park,
None;

Y. B. Park,
None;

S. K. Lee,
None;

J. J. Song,
None.

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