ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2157

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:

Session Information

Session 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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