Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Anti-tumor necrosis factor-α (TNF-α) therapy is associated with an increased risk of mycobacterium tuberculosis infection. Tuberculosis (TB) reactivation can lead to severe complications in patients treated with anti-TNF-α therapy. There is little information regarding the reliability of repeated tuberculin skin tests (TST) in patients with rheumatic diseases on anti-TNF-α therapy. The aim was to assess the usefulness of repeat tuberculosis screening tests in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) on anti-TNF-α therapy, and to identify risk factors associated to positive TST conversion.
Methods: We performed a case-control retrospective study nested in a cohort of patients with rheumatic diseases on prolonged anti-TNF-α therapy (≥12 months) with baseline negative TST. The study period was from January 2009 to December 2014. Patients with at least one new TST ≥12 months on anti-TNF-α therapy were included. The patients were allocated in two groups: Group I, patients with positive TST (induration size ≥5 mm after 48-72 hours), and Group 2, patients with negative TST. We analyzed baseline variables that potentially had predictive value for TST conversion, including age, sex, rheumatic diseases, DMARD’s therapy, glucocorticoid use, previous TB exposure, BCG vaccination, and anti-TNFα therapy. The statistical analysis included t-test and Chi square test. A logistic regression analysis was performed and odd ratios (OR) were calculated.
Results: We included 105 patients, 47 (56.6%) were female. The mean age was 44.3±11.1 years. The diagnoses included RA (n=53), AS (n=46), and PsA (n=6). Twenty-six patients (24.7%) had positive TST conversion. We observed a significant difference in disease evolution between Group 1 (95.42 ± 51.45 months) and Group 2 (140.66 ±104.3 months) (p=0.036). In the logistic regression analysis, infliximab use was the only associated variable with positive TST conversion (OR 2.2 [IC 95% 1.1-4.2], p=0.01) (Table).
Conclusion: Our study shows that about 25% of patients on anti-TNF-α treatment developed positive TST conversion. The incidence rate of positive TST conversion in patients on anti-TNF-α therapy seems to be high in our population, especially with the use of infliximab. The TST should be recommended in high risk population on anti-TNF-α during follow-up.
|
anti-TNF-α therapy |
|
Group 1 (TST +) n=26 |
Group 2 (TST -) n=79 |
OR (CI 95%) |
p
|
|
Adalimumab n (%) |
|
5(20) |
20(80) |
1.07 (0.52-2.23) |
0.839 |
|
Etanercept n (%) |
|
6(16.7) |
30(83.3) |
0.86 (0.42-1.74) |
0.680
|
|
Infliximab n (%) |
|
15(34.1) |
29(65.9) |
2.2 (1.17-4.25) |
0.015 |
To cite this abstract in AMA style:
Ramos JG, Miranda D, Cruz-Dominguez P, Jara LJ, Saavedra MA. How Frequently Does Tuberculosis Screening Test Become Positive in Rheumatic Patients Treated with ANTI-Tumor Necrosis Factor-ALPHA Therapy? an Analysis of Risk Factors [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/how-frequently-does-tuberculosis-screening-test-become-positive-in-rheumatic-patients-treated-with-anti-tumor-necrosis-factor-alpha-therapy-an-analysis-of-risk-factors/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/how-frequently-does-tuberculosis-screening-test-become-positive-in-rheumatic-patients-treated-with-anti-tumor-necrosis-factor-alpha-therapy-an-analysis-of-risk-factors/