RESEARCH - Drug-specific risk of TB in patients with RA treated with anti-TNF therapy: BSRBR

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Ann Rheum Dis. 2009 Oct 22.

Drug-specific risk of tuberculosis in patients with rheumatoid

arthritis treated with anti-TNF therapy: Results from the British

Society for Rheumatology Biologics Register (BSRBR).

Dixon WG, Hyrich KL, KD, Lunt M, Galloway J, Ustianowski A, Symmons DP.

1 University of Manchester, United Kingdom;

BACKGROUND: The risk of tuberculosis (TB) in patients with rheumatoid

arthritis (RA) is thought to be increased following anti-TNF therapy,

with a proposed differential risk between the anti-TNF drugs

etanercept (ETA), infliximab (INF) and adalimumab (ADA). We aimed to

compare directly the risk between drugs, to explore time to event,

site of infection and the role of ethnicity.

METHODS: and findings: Using data from the British Society for

Rheumatology Biologics Register (BSRBR), a national prospective

observational study, we compared TB rates in 10712 anti-TNF treated

patients (3913 ETA, 3295 INF, 3504 ADA) and 3232 patients with active

RA treated with traditional disease-modifying anti-rheumatic drugs.

RESULTS: To April 2008, 40 cases of TB were reported, all in the

anti-TNF cohort. The rate of TB was higher for the monoclonal

antibodies ADA (144 events/ 100,000 person years (pyrs)) and INF

(136/100,000 pyrs) than ETA (39/ 100,000 pyrs). After adjustment, the

incidence rate ratio compared to ETA-treated patients was 3.1 (95% CI

1.0, 9.5) for INF and 4.2 (1.4, 12.4) for ADA. The median time to

event was lowest for INF (5.5 months) compared to ETA (13 months) and

ADA (18.5 months). 13/40 cases occurred after stopping therapy. 25/40

(62%) cases were extra-pulmonary, of which 11 were disseminated.

Patients of non-white ethnicity had a six-fold increased risk of TB

compared to white patients treated with anti-TNF therapy.

CONCLUSION: The rate of TB in patients with RA treated with anti-TNF

therapy was 3-4 fold higher in patients receiving INF and ADA compared

to ETA.

PMID: 19854715

http://www.ncbi.nlm.nih.gov/pubmed/19854715

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