Biologic therapies have resulted in a sea change in the management of inflammatory arthritis; however, a higher risk of opportunistic infection, particularly tuberculosis (TB), is well recognised. This has led to the development of TB screening guidelines. The aim of this study was to investigate the prevalence of latent TB in patients prescribed biologic therapy in an endemic area (prevalence of TB 50/100,000) and to assess the risk of subsequent reactivation. Retrospective case note review of all patients with inflammatory arthritis ever prescribed biologic therapy between 1998 and 2014 at our centre. Two hundred ninety-nine patients (109 men, 190 women) who had ever been prescribed biologic therapy over a 16-year period were included. Mean age upon commencing the biologic therapy was 51 years. Two hundred eighteen (73 %) patients were Caucasian with remaining from ethnic minorities. Two hundred thirty-nine (80 %) prescriptions were for TNF inhibitors. Median duration of biologic therapy was 4.2 years for those who remained on treatment prior to stopping or switching therapies. During 1998-2007, 112 patients underwent clinical assessment, chest X-ray and check for BCG scar. One patient of Asian origin developed extrapulmonary TB within 6 weeks of adalimumab initiation. Following a year of anti-TB treatment, he restarted the biologic therapy with no ill effects. One hundred eighty-seven participants (who started on biologic therapy between 2008 and 2014) underwent additional interferon gamma release assays (IGRA) testing as part of a new TB screening protocol (T-spot test). Eighteen (10 %) had positive test with normal chest X-rays. Six patients were white, nine of Asian origin and three others. Three Caucasian patients had a borderline result. All had 3 months of isoniazid and rifampicin with simultaneous prescription of biologic agent (13 had TNF antagonist, 5 rituximab and 3 tocilizumab). No cases of active TB infection were observed. Overall prevalence of latent TB in patients with inflammatory arthritis prescribed biologic therapy in an endemic area is 10 %. The risk warrants careful screening and monitoring in all patients. Adherence to strict screening protocol reduces the risk of active TB infection irrespective of the biologic therapy employed.
BackgroundBiologic agents have led to a sea change in the management of inflammatory arthritis however higher risk of opportunistic infections particularly tuberculosis (TB) is well recognised. This has led to the development of TB screening guidelines.ObjectivesThe aim of this study was to investigate the prevalence of latent TB in patients prescribed biologic therapy in a TB endemic area (prevalence 50/100,000) and to assess the risk of subsequent reactivation.MethodsRetrospective case note review of all patients with inflammatory arthritis ever prescribed biologic therapy between 1998 and 2014 at our centre.Results299 patients (109 men: 190 women) who have had biologic therapy over sixteen years were included. Mean age upon commencing the biologic was 51 years. 203 (68%) participants had rheumatoid arthritits, 30 (10%) psoriatic arthritis, 48 (16%) axial spondyloarthropathy and 18 (6%) juvenile idiopathic arthritis. 218 (73%) patients were Caucasian, 59 (20%) Asian, 15 (5%) Afro-Caribbean and the remaining 7 were mixed race. 239 (80%) prescriptions were issued for TNF inhibitors (98 for etanercept and remaining for monoclonal antibodies). 33 patients had rituximab, 17 had tocilizumab and 3 were initiated on abatacept. Seven had stopped TNF inhibitors. Median duration of biologic therapy was 4.2 years for those who remained on treatment prior to stopping or switching therapies.Prior to the implementation of TB screening in the unit in 2007, 112 patients underwent clinical assessment, chest x-ray and check for BCG scar. One patient of Asian origin developed extra-pulmonary TB within six weeks of adalimumab initiation. Following a year of antiTB treatment, he restarted the biologic therapy with no ill effect. 187 participants underwent additional interferon gamma release assay (IGRA) testing as part of new protocol (T Spot test). 18 (10%) had positive test with normal chest xrays. Six patients were white, 9 of Asian origin and 3 others. Three Caucasian patients had borderline result. All had 3 months of isoniazid and rifampicin with simultaneous prescription of biologic agent (13 had TNF antagonist, 5 rituximab and 3 tocilizumab). No cases of active TB infection were observed.ConclusionsPrevalence of latent TB in patients with inflammatory arthritis prescribed biologic therapy in an endemic area is 10%. The risk is independent of ethnicity and warrants careful screen and monitoring in all patients. Adherence to strict screening protocol reduces the risk of active TB infection irrespective of the biologic therapy employed.Disclosure of InterestNone declared
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.