Session Information
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose:
Opportunistic infections are a major risk in with biological drugs therapy, being tuberculosis (TB) one of the most relevant.
Objectives: evaluate the frequency of the TB infections in patients from a national rheumatic disease database treated with biological drugs (BD)
Methods:
Patients included belong to BIOBADASAR, a database of rheumatic disease patients treated with BD in Argentina, created in 2010; this database includes patients diagnosed according with accepted criteria , treated with BD, and controls matched for diagnosis age and sex, not treated with BD.
Demographic, clinical and treatment characteristics were evaluated
The continuous variables are expressed as mean (M), average (m) and standard deviations (SD), inter Quartil range (IQR) or frequency as appropriate. An analysis of logistical regression was made to determine odds ratio (OR) and 95% confidence intervals (CI95%).
Results:
As of march 2015, 2928 patients were evaluated, 1709 (58.4%) had treatment with BD, and 1219 (41,6%) matched controls
Diagnoses were: Rheumatoid Arthritis (RA) 2315 (79.1%), Psoriatic Arthritis (PsA) 234 (8 %) and lupus 108 (3.7 %). Women (79.1 %), age 42.9±16.2.
BD include: anti TNF 1770, Abatacept 239, Rituximab 199, Tocilizumab 107, Tofacitinib 32, Belimumab 19, Ustekinumab 2, Anakinra 1; received more than one BD 355 (20.7%).
Of the 2928 patients, 13 (0.04%) had a TB diagnosed according to accepted criteria; 11( 0.64%) were treated with BD, other 2 (0.16%) patients belonged to the non biologic treatment group; 12 (92,5%) of the TB patients had RA and 1 (7.7%) PsA
In 1701 patients (58.1%) PPD was performed, 119 (6,9 %) were positive > 5 mm, 93 (68.1%) treated with BD, one later developed TB
In 2100 patients, 71.7% chest x ray was performed with 31 (1.5%) showing pulmonary infiltrates, 25 (80.6%) treated with BD, none developed TB
Pulmonary TB was diagnosed in 11 (84.6%) patients. 2 (15.3%) had extra pulmonary disease; 12 patients (92.3 %) had full recovery one continues on therapy.
Time elapsed from onset of BD treatment until TB diagnosis was 12, RIQ 6-104 months.
Table 1: Tuberculosis risk according to treatment. Analysis of logistic regression
|
|
p |
OR |
CI 95% |
|
non-biological |
0.13 |
Reference |
Reference |
|
Etanercept |
0.25 |
3,72 |
0,68-20,38 |
|
Adalimumab |
1.00 |
3,20 |
0,44-22,77 |
|
Abatacept |
0.05 |
7,14 |
1,00-51,0 |
|
Infliximab |
0.10 |
7,26 |
0,65-80,97 |
|
Tocilizumab |
<0.01 |
15,65 |
2,17-12,60 |
Conclusion:
There was a low frequency of TB, with a significant difference in the biological drug treated group
Most the TB patients had pulmonary disease.
Most TB cases appeared after one year of therapy
To cite this abstract in AMA style:
Benzaquén N, Haye Salinas M, Pirola JP, Encinas LM, Caeiro F, Alvarellos AJ, de la Vega MC Sr., Casado G, Gomez G Sr., Citera G, Gallardo MDLA, Quinteros A, Exeni IE, Medina MA, Astesana P, Sanchez Andia C, Gómez G, Granel A, Dubinsky D, Capuccio A, Eimon A, Quintana R, Pons-Estel B, Mussano E, Scarafia S, García MA, De La Sota M, Kirmayr K, Velozo EJ, Paira S, Bertoli AM, Caprarulo C, Aguero S, Battagliotti C, Soares de Souza S, Cavillion E, Perez Davila A, Barreira JC, Larroude M, Tamaño F, Peluzzoni A, Saurit V. Tuberculosis in Patients Treated with Biological Drugs [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/tuberculosis-in-patients-treated-with-biological-drugs/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/tuberculosis-in-patients-treated-with-biological-drugs/