Follow-up results of 702 patients receiving tumor necrosis factor-alpha antagonists and evaluation of risk of tuberculosis

Çağatay, Tülin; Aydin, Munevver Mertsoylu; Sunmez, Sule; Çağatay, Penbe; Gulbaran, Ziya; Gül, Ahmet; Artım, Bahar; Kılıçaslan, Zeki

doi:10.1007/s00296-009-1170-6

Cited by 34 publications

(34 citation statements)

References 20 publications

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“…Similar to the other two studies from Turkey, we have found a high prevalence of latent tuberculosis (6,7). This rate was higher than the rates in Vanhoof et al (5) and Haroon et al (4).…”

Section: Discussionsupporting

confidence: 89%

“…When other studies from our country are evaluated, the frequency of hepatotoxicity has been reported to be 3.5%-8.3% (6,7). Although the hepatoxicity criterion was accepted as a 2-fold increase in liver enzymes in our study, hepatotoxicity was found only in two patients Liver injury has been documented with DMARDs, especially MTX.…”

Section: Discussionmentioning

confidence: 51%

“…This was severe in 3 patients (5). In a study by Çağatay et al (6), 702 patients with different inflammatory diseases receiving TNF-α antagonists were evaluated. Chemoprophylaxis was administered overall to 583 (83%) patients, and 31 patients (5.3%) developed hepatotoxicity.…”

Section: Discussionmentioning

confidence: 99%

“…It is well known that the combination of TNF inhibitors and methotrexate (MTX) increases their therapeutic effect. However, it can be speculated that INH-induced liver toxicity may be seen at an increased rate when it is combined with a TNF inhibitor and MTX, because they can be potentially harmful to the liver (4)(5)(6)(7)(8)(9)(10). In the literature, there are conflicting studies of the frequency of INH-induced hepatotoxicity in rheumatic patients receiving anti-TNF-α agents.…”

Section: Introductionmentioning

confidence: 99%

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Does isoniazid chemoprophylaxis increase the frequency of hepatotoxicity in patients receiving anti-TNF-α agent with a disease-modifying antirheumatic drug?

et al. 2014

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Objective: The aim of this study is to determine the incidence of isoniazid (INH)-related hepatotoxicity in patients with rheumatologic diseases receiving tumor necrosis factor-α (TNF-α) antagonists along with a disease-modifying antirheumatic drug (DMARD). Material and Methods:We have retrospectively evaluated 87 patients receiving anti-TNFα agents who were followed up between June 2005and February 2010 at our rheumatology department. Sixty-one of 87 patients have received INH prophylaxis for 9 months for latent tuberculosis infection.Results: A total of 61 (70.1%) of 87 patients used INH prophylaxis (Group I), while the remaining 26 (29.9%) (Group II) had not; 53 patients had used any DMARD in Group I, while 21 patients had used in Group II. No significant differences were found among Group I and II with respect to clinical features. When two groups were compared, in Group I, elevations of liver enzymes were detected in five patients (8.1%) who had normal baseline values. Among these patients, hepatotoxicity developed in two patients. Hepatotoxicity developed one patient in Group II (p=0.85). Conclusion:INH chemoprophylaxis was well tolerated in patients using anti-TNF-α agent and a DMARD. It seems not to be a strong risk factor for hepatotoxicity. However, comorbidities and other drugs used may be additional factors in the elevation of transaminases.

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“…Similar to the other two studies from Turkey, we have found a high prevalence of latent tuberculosis (6,7). This rate was higher than the rates in Vanhoof et al (5) and Haroon et al (4).…”

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does isoniazid chemoprophylaxis increase the frequency of hepatotoxicity in patients receiving anti-TNF-α agent with a disease-modifying antirheumatic drug?

et al. 2014

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“…On the other hand, limited data from this country regarding the incidence of TB in patients undergoing aTNF-α-T suggests an 11-40 times higher risk of TB compared to the general population [5,19,20,21,22]. …”

Section: Introductionmentioning

confidence: 99%

Factors Affecting the Tuberculosis Risk in Patients Receiving Anti-Tumor Necrosis Factor-α Treatment

et al. 2015

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Background: Tumor necrosis factor (TNF)-α inhibitors are known to increase the risk of tuberculosis (TB). Objectives: To examine the factors associated with an increased risk of TB in patients receiving anti-TNF-α treatment (aTNF-α-T). Method: Of 3,094 patients who received aTNF-α-T between 2003 and 2013, a total of 1,964 subjects with a follow-up time longer than 6 months were identified and included in this retrospective analysis. Potential risk factors for the development of TB in patients receiving aTNF-α-T were evaluated. Results: Of the 1,964 patients, 1,009 (51%) were male and 955 (49%) were female, with a mean age of 39.7 ± 13.9 years. The primary conditions requiring aTNF-α-T included ankylosing spondylitis (n = 875), rheumatoid arthritis (n = 711), Behçet's disease (n = 83), and others (n = 295). Sixteen patients [8 (50%) males and 8 (50%) females; 5 (31.2%) with pulmonary TB and 11 (68.8%) with extrapulmonary TB] developed TB, with a corresponding TB incidence of 466/100,000. No significant associations were found between age, gender, smoking history, pack-years of smoking, isoniazid (INH) chemoprophylaxis, type of anti-TNF-α agent, use of other immunosuppressive drugs, and the risk of TB (p > 0.05). Multivariate logistic regression analysis showed a significantly higher risk of TB in patients diagnosed with Behçet's disease, and a significantly lower risk of TB in patients with a tuberculin skin test wheal ≥10 mm in diameter (p < 0.05). Conclusion: aTNF-α-T is associated with an increased risk of pulmonary or extrapulmonary TB, even when follow-up protocols and INH chemoprophylaxis are implemented, and TB often develops in the later stages of treatment. The risk of TB was higher in patients with Behçet's disease and lower in patients who had a strong tuberculin skin test reaction.

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Liver diseases associated with anti-tumor necrosis factor-alpha (TNF-α) use for inflammatory bowel disease

Coffin¹,

Fraser²,

Panaccione³

et al. 2011

Inflammatory Bowel Diseases

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The conventional treatment of inflammatory bowel disease (IBD) has focused on nonspecifically targeting mucosal inflammation. In the last decade, with the advent of novel biological agents that directly inhibit proinflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), rapid progress has been made in clinical management of complex and challenging patients with IBD. However, there remain many unanswered questions about the short and long-term side effects; this article focuses on hepatic complications. This review aims to provide a concise update to gastroenterologists on the well-known, as well as the potential rare consequences of anti-TNFα therapy on the liver and recommendations for clinical management. We performed a focused literature review for reports of the effect of anti-TNF therapy on preexisting liver disease as well as de novo hepatitis and drug-induced hepatotoxicity. Search terms used included anti-TNF therapy, biologics, liver disease, inflammatory bowel disease, hepatitis, hepatotoxicity, opportunistic infections,, and hepatitis virus reactivation. There are multiple potential effects of anti-TNF therapy on the liver during treatment of patients with IBD. Often treatment may be complicated by preexisting chronic liver disease. Clinicians should be aware of potential hepatic side effects and appropriate management options.

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Follow-up results of 702 patients receiving tumor necrosis factor-alpha antagonists and evaluation of risk of tuberculosis

Cited by 34 publications

References 20 publications

Does isoniazid chemoprophylaxis increase the frequency of hepatotoxicity in patients receiving anti-TNF-α agent with a disease-modifying antirheumatic drug?

Does isoniazid chemoprophylaxis increase the frequency of hepatotoxicity in patients receiving anti-TNF-α agent with a disease-modifying antirheumatic drug?

Factors Affecting the Tuberculosis Risk in Patients Receiving Anti-Tumor Necrosis Factor-α Treatment

Liver diseases associated with anti-tumor necrosis factor-alpha (TNF-α) use for inflammatory bowel disease

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