Background/Purpose: Treatment with biologic therapy has been associated with a high risk of reactivation of latent tuberculosis (TB ). Preventive strategies for tuberculosis remain a crucial step before initiating biologics in rheumatic disease.

The study aimed to access the effectiveness of TB screening recommendations before the initiation of biological therapy and identify the incidence of active TB among these patients.

Methods: We performed a hospital-based retrospective cohort study among rheumatic disease patients on biological therapy in two centers in Jeddah between January 2005 to December 2019. Medical files were retrospectively reviewed for demographics data, baseline screening for TB, use of prophylaxis, information on DMARDs and biological therapies, and outcomes results were collected.

Results: A total of 365 patients were included over a period of 14 years. Two hundred ninety-two (80%) had  Rheumatoid arthritis (RA),13% psoriatic arthritis (PSA), 9% spondyloarthritis (SPA), 2% SLE, and 4% others. The mean age was 47.54 (±14.2), 311 (85%) were females with a mean duration of disease 8.45 years (± 6.58). Hundred forty-nine (42.3%) were on steroids. Anti TNFs were prescribed in 213 (58.4%) patients, Non Anti-TNFs 124 (36.6%)  patients, and Jak inhibitors 18 (5%) patients.TB screening was done to all patients except 3 patients (data missing) before commencing biologics. Forty-four (12.1%) patients had latent TB at baseline and all received chemoprophylaxis with isoniazid before starting biologics. There was no significant difference in patients with latent TB and those without regarding the demographics, comorbid illnesses, old TB, inflammatory markers, BMI, or steroid use.

Four patients with active TB were identified (one with Behcet’s disease and three with RA). One patient had a reactivation of latent TB and 3 patients developed de novo TB. Three out of four had an infection in the first 6 months of treatment (one on infliximab and two on rituximab) and one case after 1 year of stopping adalimumab. Two cases had pulmonary TB and two others with extrapulmonary  TB (pericarditis and brain abscess each). All four patients with active TB  were treated with standard anti TB medications. Three had complete resolution of their TB and one died.

Conclusion: Baseline screening has been effectively carried out in our cohort as per recommendations. Physicians should be vigilant for symptoms and signs of active TB as not only reactivation of latent TB can occur with patients on biologics but also de novo TB can occur.

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/effectiveness-of-screening-in-patients-with-rheumatic-disease-before-commencing-biologic-therapy-and-risk-of-active-tuberculosis/