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Abstract Number: 1363

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

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Session Information

Session 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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