Tuberculosis Reactivation Risk in Patients Treated with Tumor Necrosis Factor Alpha Inhibitors: A Turkish Experience with Higher Mortality and Different Background Diseases

Bunyamin Kisacik¹, Omer Pamuk², Ahmet Mesut Onat³, B. Erer⁴, Gulen Hatemi⁵, Yesim Ozguler⁶, Yavuz Pehlivan⁷, Levent Kilic⁸, Ihsan Ertenli⁸, Meryem Can⁹, Haner Direskeneli⁹, Gökhan Keser¹⁰, Fahrettin Oksel¹⁰, Ediz Dalkilic¹¹, Sedat Yilmaz¹², Salih Pay¹³, Ayse Balkarli¹⁴, Veli Cobankara¹⁵, Gozde Yildirim Cetin¹⁶, Mehmet Sayarlioglu¹⁷, Ayse Cefle¹⁸, Ayten Yazici¹⁸, Ali Berkant Avci¹⁹, Ender Terzioglu²⁰, Suleyman Ozbek²¹, Servet Akar²² and Ahmet Gül²³, ¹Rheumatology, Gaziantep University, School of Medicine, Gaziantep, Turkey, ²Trakya Üniversitesi, edirne, Turkey, ³Rheumatology, Gaziantep University School of Medicine, Gaziantep, Turkey, ⁴Istanbul Faculty of Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey, ⁵Istanbul University, Cerrahpasa Medical Faculty, Rheumatology, Istanbul, Turkey, ⁶University of Istanbul, Cerrahpasa Medical Faculty, Rheumatology, Istanbul, Turkey, ⁷Rheumatology, Uludag University, School of Medicine, Bursa, Turkey, ⁸Hacettepe Üniversity, Ankara, Turkey, ⁹Marmara Üniversitesi, Ýstanbul, Turkey, ¹⁰Ege Üniversitesi, Ýzmir, Turkey, ¹¹Uludað Üniversitesi, Bursa, Turkey, ¹²GATA, ANKARA, Turkey, ¹³GATA, Ankara, Turkey, ¹⁴Pamukkale Üniversitesi, Denizli, Turkey, ¹⁵Denizli Üniversitesi, Denizli, Turkey, ¹⁶Deparment of Rheumatology, Sutcu Imam University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Kahramanmaras, Turkey, ¹⁷Rheumatology, Ondokuz Mayis University School of Medicine, Samsun, Turkey, ¹⁸Department of Rheumatology, Kocaeli University, Kocaeli, Turkey, ¹⁹Antalya University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Antalya, Turkey, ²⁰School of Medicine, Akdeniz University, Antalya, Turkey, ²¹Cukurova Üniversitesi, Adana, Turkey, ²²Katip Çelebi Üniversitesi, Ýzmir, Turkey, ²³Department of Internal Medicine, Rheumatology Division, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Biologic agents and tuberculosis

Session Information

Title: Infections, Infection-related Biomarkers and Impact of Biologic Therapies

Session Type: Abstract Submissions (ACR)

Background/Purpose

Tumor necrosis factor alpha inhibitors (anti-TNF) are a breakthrough for the treatment of inflammatory rheumatic diseases and tuberculosis (TB) is the prevailing and vitally important infectious complication. This retrospective data analyzes the risk of tuberculosis reactivation and demographic features of patients treated with anti-TNF drugs in Turkey, where TB is still a widespread endemic disease.

Methods

The study is held by Turkish Multi-centered Investigators Platform in Rheumatology (TULIP).10.434 patients treated with anti-TNF drugs, 73 (0.69%) patients were diagnosed with TB (M/F: 39/34), 7.695 patients with accurate and complete data of laboratory and clinical history were enrolled as control group.

Results

Among 73 patients diagnosed with TB, 38 patients were diagnosed with ankylosing spondylitis, 25 with rheumatoid arthritis, 4 with psoriatic arthritis, 5 with Behcet’s syndrome, and a patient with vasculitis. TB frequency in patients using infliximab (1.27%) was significantly higher than patients using etanercept (0.3%) and adalimumab (0.57%) (p <0.001 and 0.008, respectively). Six patients out of 73 TB cases (8.2%) died under follow-up. Thirty-four cases (46.6%) out of 73 TB patients had pulmonary tuberculosis. In the logistic regression model, type of anti-TNF (infliximab) (OR: 3.4, 95%CI: 1.88-6.1, p=0.001) and insufficient prophylaxis (<9 months) (OR: 3.15, 95%CI: 1.43- 6.9, p=0.004) were independent predictors of TB development among anti-TNF treated patients.

Conclusion

Our results suggest that TB is an important complication of anti-TNF therapies in Turkey, where the disease is still endemic. TB chemoprophylaxis less than nine months and the use infliximab therapy were independent risk factors for TB development.

Disclosure:

B. Kisacik,
None;

O. Pamuk,
None;

A. M. Onat,
None;

B. Erer,
None;

G. Hatemi,
None;

Y. Ozguler,
None;

Y. Pehlivan,
None;

L. Kilic,
None;

I. Ertenli,
None;

M. Can,
None;

H. Direskeneli,
None;

G. Keser,
None;

F. Oksel,
None;

E. Dalkilic,
None;

S. Yilmaz,
None;

S. Pay,
None;

A. Balkarli,
None;

V. Cobankara,
None;

G. Yildirim Cetin,
None;

M. Sayarlioglu,
None;

A. Cefle,
None;

A. Yazici,
None;

A. B. Avci,
None;

E. Terzioglu,
None;

S. Ozbek,
None;

S. Akar,
None;

A. Gül,
None.

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