ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1450

Safety Of Resuming The Tumor Necrosis Factor Antagonists Therapy In Patients Who Developed Tuberculosis After Use Of Tumor Necrosis Factor Antagonists

Seokchan Hong1, You Jae Kim2, Bon San Koo2, Kyung joo Ahn3, Wook Jang Seo4, Yong-Gil Kim2, Chang-Keun Lee2 and Bin Yoo2, 1Department of rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea, 2Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea, 3KEPCO medical center, Seoul, South Korea, 4Seoul Veterans Hospital, Seoul, South Korea

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Rheumatoid Arthritis Treatment - Small Molecules, Biologics and Gene Therapy II

Session Type: Abstract Submissions (ACR)

Background/Purpose: Tuberculosis is one of the most serious adverse events related to tumor necrosis factor (TNF) antagonists in inflammatory diseases. However, there is no consensus on the current treatment guidelines about resuming TNF blockers after development of active tuberculosis infection (TI). Our objective was to analyze the optimal time-point for resuming the TNF antagonist with no relapse of TI.

Methods: Retrospective study has included 683 patients from June 2003 to December 2012 (362 ankylosing spondylitis; 307 rheumatoid arthritis; 10 psoriatic arthritis; 4 Behcet’s disease), who have started TNF blockers at a single tertiary hospital. Data on cases of active TI during biologics were collected and the outcomes of resuming TNF blockers were evaluated.

Results: Of the 683 patients, 15 (2.1%) patients (6 female, mean age 47.4 ± 17.5 years) were diagnosed with active tuberculosis during anti-TNF treatment. Diagnoses were: 10 ankylosing spondylitis; 4 rheumatoid arthritis; 1 Behcet’s disease. Tuberculosis was detected in one patient by routine CXR and in others by the development of symptoms such as fever. The type of tuberculosis infection was: pulmonary in 7 patients; gastrointestinal in 3; lymph nodes in 2; disseminated in 1, miliary in 1, pericardium in 1. The TNF blocker used at TI diagnoses was; 4 etanercept, 4 adalimumab, and 7 infliximab. The mean duration of anti-TNF treatment before development of TB was 26.7± 28.1 months. Anti-TNF treatment was reinitiated in 6 (40%) patients; 4 patients during under treatment of TI treatment (mean TI treatment of 1.5 ± 1.0 months) and 2 patients after completion of TI treatment. Four patients reinitiated with the same agents, whereas 2 patients started with another TNF blocker. All six patients successfully completed anti-tuberculosis treatment and showed good responses. The outcomes in patients after reinitiation of anti-TNF treatment were favorable that no patients had a relapse of TI after a mean follow-up duration of 28 ± 18.1 months.

Conclusion: Active tuberculosis infection in relation to TNF antagonist may be safe for resuming the therapy even before completion of TI treatment. Our results may suggest that it is possible to restart TNF blockers if patients were treated concomitantly with adequate anti-tuberculosis treatment.

Disclosure:

S. Hong,
None;

Y. J. Kim,
None;

B. S. Koo,
None;

K. J. Ahn,
None;

W. J. Seo,
None;

Y. G. Kim,
None;

C. K. Lee,
None;

B. Yoo,
None.

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