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.
Y. J. Kwon,
Y. G. Song,
S. W. Lee,
M. C. Park,
Y. B. Park,
S. K. Lee,
J. J. Song,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/active-tuberculosis-risk-with-tumor-necrosis-factor-inhibitors-after-treating-latent-tuberculosis-a-7-year-retrospective-observational-study/