RESEARCH - MTX combined with isoniazid treatment for latent TB is well tolerated in patients with RA

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Published Online First: 20 August 2007. doi:10.1136/ard.2007.076406

ls of the Rheumatic Diseases 2008;67:462-465

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EXTENDED REPORTS

Methotrexate combined with isoniazid treatment for latent tuberculosis

is well tolerated in patients with rheumatoid arthritis: experience

from an urban arthritis clinic

A Mor 1, C O Bingham III 2, M Kishimoto 1,3, P M Izmirly 1, J D

Greenberg 1, S Reddy 1, P B Rosenthal 1

1 Division of Rheumatology, Department of Medicine, New York

University School of Medicine, New York, NY, USA

2 Divisions of Rheumatology and Allergy and Clinical Immunology, s

Hopkins University, Baltimore, MD, USA

3 Department of Rheumatology, Kameda Medical Center, Kamogawa, Japan

Objectives: Reactivation of Mycobacterium tuberculosis (TB) is a

significant problem with all available tumour necrosis factor (TNF)

antagonists when used to treat rheumatoid arthritis (RA), psoriatic

arthritis, psoriasis and other inflammatory diseases. Concerns have

been raised regarding the appropriate management of patients with

latent TB (LTB) exposure (or active TB infection) before initiating

TNF antagonists as the safety data of combined treatment with two

potentially hepatotoxic medications, methotrexate (MTX) and isoniazid

(INH), is lacking. The goal of this study was to investigate the

toxicity of MTX and INH treatment in patients with RA before

initiating TNF antagonists.

Methods: To investigate the toxicity of MTX and INH treatment in

patients with RA we performed a retrospective chart review of patients

seen at the Bellevue Hospital Arthritis Clinic in New York City

between 2002 and 2006. Forty-four patients who were concomitantly

treated with both drugs were included. The primary outcome

investigated was increase in liver function tests (LFT).

Results: Transient increases in LFT were seen in 11% of patients, but

in no case was this more than twice the upper limit of normal values.

All abnormal LFT resolved spontaneously without intervention. In

addition, no patient has developed signs or symptoms of TB

reactivation.

Conclusions: The use of INH for LTB was well tolerated in patients

with RA on a background regimen of MTX. While the risks and benefits

of all treatment must always be considered, in our experience the

additive risk of INH to MTX in terms of hepatotoxicity was low. None

the less it is prudent to follow LFT closely on patients taking this

combination.

http://ard.bmj.com/cgi/content/abstract/67/4/462

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