Intermediate to long-term follow-up results of INH chemoprophylaxis prior to anti-TNF-alpha therapy in a high-risk area for tuberculosis

Kurt, Bahar; Talay, Fahrettin; Tuğ, Tuncer; Soy, Mehmet; Beş, Cemal; Hayran, Mutlu

doi:10.1007/s00508-013-0417-0

Cited by 8 publications

(9 citation statements)

References 14 publications

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“…The TST is convenient, inexpensive, and easy to administer, rendering it a very efficient test for determining LTBI screening. Some studies detected no association between TST positivity and prior BCG vaccination, 21,22 although most studies indicated that TST was affected by previous BCG vaccination and immunosuppressive treatment 17,18,23 . As most of our patients were receiving immunosuppressive drugs before LTBI screening, it is likely possible to have false‐negative results with performing TST instead of the IGRA test for LTBI screening.…”

Section: Discussionmentioning

confidence: 87%

“…In a study conducted by Kurt et al 22 A diagnosis of LTBI was based on TST ≥5 mm in patients who were candidates for anti‐TNF treatment. TST was positive in 58 (79.4%) of 73 patients, including 50 (68.5%) with BCG vaccination who were treated with anti‐TNF agents for the rheumatological disease, and none of the patients (0%) developed signs of TB during 24 months of follow‐up.…”

Section: Discussionmentioning

confidence: 99%

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Determination of tuberculin skin test for isoniazid prophylaxis in BCG vaccinated children who are using anti‐TNF agents for rheumatologic diseases

Kılınç

Önal

Öztosun

et al. 2020

Pediatric Pulmonology

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Objective The use of tumor necrosis factor inhibitors (anti‐TNF) has a risk of activating latent tuberculosis infection (LTBI). This study was performed to investigate LTBI according to tuberculin skin test (TST) size and to determine the frequency of tuberculosis (TB) in bacillus Calmette‐Guerin (BCG)‐vaccinated children receiving anti‐TNF treatment for rheumatological disease. Materials and Methods The study consisted of 559 children. Information on demographics, anti‐TNF agents, TST size, and isoniazid (INH) prophylaxis was recorded. Patients (n = 254) with TST size ≥5 mm were divided into three groups according to TST size and INH prophylaxis: group 1, TST size 5 to 9 mm and no INH prophylaxis; group 2, TST size 5 to 9 mm with INH prophylaxis; and group 3, TST size ≥10 mm with INH prophylaxis. Results The 559 patients comprised 314 (56.3%) females and 245 (43.6%) males; they had a mean age of 13.1 ± 4.1 years. The mean TST size in all patients was 4.2 ± 4.7 mm. Group 1 consisted of 76 (29.9%) patients, group 2 consisted of 88 (34.6%) patients, and group 3 consisted of 90 (35.4%) patients. The mean TST sizes for the three groups were 6.8 ± 3.1 mm, 7.2 ± 3.2 mm, and 13.9 ± 2.8 mm, respectively. New TB was diagnosed in only two (0.35%) patients. Both of them were in group 3. Conclusions A TST size of ≥10 mm in BCG‐vaccinated children receiving anti‐TNF treatment may distinguish children at high risk for reactivation of LTBI.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Determination of tuberculin skin test for isoniazid prophylaxis in BCG vaccinated children who are using anti‐TNF agents for rheumatologic diseases

Kılınç

Önal

Öztosun

et al. 2020

Pediatric Pulmonology

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“…In a prospective study with rheumatic diseases of 86 patients, chemoprophylaxis has been given 58 cases for 9 months and TB disease was not detected at the two month follow up [29]. In our study, we followed up 2 of 110 patients (1.8%).…”

Section: Discussionmentioning

confidence: 89%

Should isoniazid prophylaxis be prescribed to the patients under tumor necrosis factor-alpha antagonists independent of tuberculin skin test?

Alasan¹,

Balbay

Cangür

et al. 2019

The Aging Male

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“…Similarly, the rate of tuberculosis development was reported as 0.85% by Çağatay et al, and 1.5% by Hanta et al(18,19). Contrary to these studies, Girit et al and Kurt et al reported that tuberculosis did not develop in any of the patients receiving anti-TNF (14,20). Con icting results have been reported in studies examining the bene t of prophylaxis for LTBI.…”

Section: Discussionmentioning

confidence: 92%

Evaluation of Tuberculosis in Children Using Biological Agent Therapy

Kara

KIZIL

Nepesov

et al. 2022

Preprint

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Introduction: Treatment with biological agents, which are classified as monoclonal antibodies, cytokines and fusion proteins, increases patient risk for developing tuberculosis (TB) and non-tuberculous mycobacterial infections. In this study, we aimed to investigate the risk of tuberculosis development in pediatric patients using anti-TNF drugs.Method: One hundred and fifteen pediatric cases who were followed up in Eskişehir Osmangazi University Faculty of Medicine, Department of Pediatrics between January 2011 and December 2021 and received anti-TNF and biological agent treatment were included in the study. The clinical and epidemiological characteristics of the cases were analyzed retrospectively.Results: One hundred and fifteen cases using anti-TNF drugs were included in the study. The mean age of the cases was 13 (2-18) years. Of the cases, 66 (57%) were female and 49 (43%) were male. Of the cases, 76 (66%) had Juvenile Rheumatoid Arthritis, 11 (9.6%) Ulcerative Colitis, 7 (6%) Crohn's, 6 (5.2%) Ankylosing Spondylitis, 5 (%4,3) FMF and 4 of them were followed up due to Psoriasis (3.5%). Etanercept in 74 (64.3%) cases, infliximab in 17 (14.8%) cases, adalimumab in 17 (14.8%) cases, anakinra in 5 (4.3%) cases, and canakinumab was using in 2 (%1.7) cases. PPD was performed in all of the cases and PPD response was measured as <5mm in 89 (77.4%), 5-9 mm in 11 (8.7%), 10-14 mm in 8 (7.4%), >15 mm in 7 (5.6%) cases. Isoniazid (INH) prophylaxis was started for 9 months in 17 cases with the diagnosis of latent tuberculosis. Active tuberculosis was not detected in any of the cases.Conclusion: All patients who are planned to receive anti-TNF therapy should be definitely screened for tüberculosis. Although it is not detected at the beginning of the treatment, regular tuberculosis screening should be continued during the treatment with contact history, symptoms, physical examination, chest X-ray and TST/IGRA in the light of current guidelines

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Intermediate to long-term follow-up results of INH chemoprophylaxis prior to anti-TNF-alpha therapy in a high-risk area for tuberculosis

Abstract: TST is a reliable and cost-effective method for the diagnosis of LTBI in patients prior to anti-TNF therapy. Moreover, chemoprophylaxis with INH seems to be effective for the prevention of TB reactivation in individuals with LTBI.

Cited by 8 publications

References 14 publications

Determination of tuberculin skin test for isoniazid prophylaxis in BCG vaccinated children who are using anti‐TNF agents for rheumatologic diseases

Determination of tuberculin skin test for isoniazid prophylaxis in BCG vaccinated children who are using anti‐TNF agents for rheumatologic diseases

Should isoniazid prophylaxis be prescribed to the patients under tumor necrosis factor-alpha antagonists independent of tuberculin skin test?

Evaluation of Tuberculosis in Children Using Biological Agent Therapy

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