RESEARCH - Effectiveness of recommendations to prevent reactivation of latent TB infection in patients treated with TNF antagonists

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Arthritis Rheum. 2005 Jun;52(6):1766-72.

Effectiveness of recommendations to prevent reactivation of latent

tuberculosis infection in patients treated with tumor necrosis factor

antagonists.

Carmona L, Gómez-Reino JJ, Rodríguez-Valverde V, Montero D,

Pascual-Gómez E, Mola EM, Carreño L, Figueroa M; BIOBADASER Group.

Spanish Society of Rheumatology, Madrid, Spain.

OBJECTIVE: To investigate the impact of official recommendations

regarding the management of latent tuberculosis (TB) infection on the

rate of active TB in patients receiving treatment with tumor necrosis

factor (TNF) antagonists. METHODS: Data on active TB rates and on

screening and treatment of latent TB infection were extracted from the

BIOBADASER (Spanish Society of Rheumatology Database on Biologic

Products), a registry of patients with rheumatic conditions treated

with TNF antagonists. The rates of active TB among the BIOBADASER

patients were compared with those in the background Spanish

population, and BIOBADASER patients with rheumatoid arthritis (RA)

were compared with a cohort of RA patients from the EMECAR (Morbidity

and Clinical Expression of Rheumatoid Arthritis) study who were not

treated with TNF antagonists and were followed up for 5 years.

RESULTS: Active TB developed in 34 patients, of whom 32 started taking

TNF antagonists prior to the official recommendations on latent TB

infection (pre-OR) and 2 began treatment after the recommendations

were issued (post-OR). All cases of TB occurred during treatment with

infliximab, and 28 of these patients had RA. Pre-OR, the active TB

rate in BIOBADASER patients was 20.9-fold higher than in the

background Spanish population, while RA patients in the BIOBADASER had

rates 22.6- and 6.2-fold higher than the background and EMECAR

populations, respectively. Post-OR, 324 patients with a tuberculin

skin test result > or =5 mm and/or chest radiograph findings

suggestive of past TB were treated for 9 months with isoniazid (INH).

Post-OR, active TB rates among the BIOBADASER patients decreased by

78% (incidence risk ratio [iRR] 0.22, 95% confidence interval [95% CI]

0.03-0.88; P = 0.008), while among RA patients in the BIOBADASER, the

rate dropped by 83% and reached the EMECAR rate (IRR 1.0, 95% CI

0.02-8.2). There were no INH treatment-related hospitalizations or

deaths.

CONCLUSION: Strategies to treat latent TB infection that are tailored

to the at-risk population can effectively and safely lessen the

likelihood of active TB in patients treated with TNF antagonists.

PMID: 15934089

http://www.ncbi.nlm.nih.gov/pubmed/15934089

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