Evaluation of Tuberculosis in Children Using Biological Agent Therapy

Abstract

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