FRI0181 Twelve years follow-up of patients with spondyloarthritis in an endemic city demonstrates high risk of active tuberculosis infection

Abstract

BackgroundAnti-tumour necrosis factor (anti-TNF) agents can induce progression from latent tuberculosis infection (LTBI) to active tuberculosis (TB) in patient with rheumatic diseases1,2. In a high tuberculosis incidence setting, TB cases developed despite the screening and treatment for LTBI.ObjectivesTo identify, in a high TB incidence setting, the TB incidence rate in patients with spondyloarthritis (SpA) during twelve years of follow-up.MethodsElectronic medical records from patients attending the SpA Clinic between 2004 and 2016 in a public university hospital were reviewed. Patients were grouped in those exposed to anti-TNF therapy and those non-exposed. The tuberculosis incidence rate (IR) was calculated for both groups and expressed as number of events per 1 00 000 patients/year; the incidence rate ratio (IRR) associated to the anti-TNF therapy was calculated.ResultsA total of 274 patients were evaluated, 102 exposed to anti-TNF drugs and 172 non-exposed. All the 102 patients underwent screening for LTBI before anti-TNF therapy: 38.2% (n=39) were diagnosed with LTBI and underwent 6 months of isoniazid preventive therapy (IPT). The total follow up time (in patients/year) was 729 in the group exposed to anti-TNF and 1243 in the group non-exposed. Ten patients were diagnosed with TB: 4 exposed to anti-TNF therapy and 6 non-exposed. Among the 4 patients exposed to anti-TNF therapy who developed TB, three had negative screening for LTBI. The TB IR (per 1 00 000 patients/year) among those exposed to anti-TNF was 548, compared to 321 in non-exposed; the IRR associated with the use of anti-TNF drugs was 1.7.ConclusionsIn a region with high TB prevalence, patients with SpA exposed to anti-TNF drugs had a higher incidence of TB compared to those who have never been exposed to these drugs. Our data reinforces the American College of Rheumatology’s recommendation that patients who live in endemic TB settings should be tested annually for LTBI.References[1] Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med2001;345(15):1098–1104.[2] De Vries MK, et al. Tuberculosis risk in ankylosing spondylitis, other spondyloarthritis and psoriatic arthritis on Sweden: a population-based cohort study. Arthritis Care Res (Hoboken)2017Dec 1. doi:10.1002/acr.23487. [Epub ahead of print]Disclosure of InterestNone declaredCBPn=98SpAn=100pSeSpeLR+MRI SIJN(%) patients with at least one structural lesion16/95(16.8%)24(24%)NS0.2 (0.2–0.3)0.8 (0.7,0.0)1.4 (0.8–2.5)N(%) patients with≥3 subchondral bone erosions10/95(10.5%)32 (32%)<0.0010.32 (0.2–0.4)0.9 (0.8–1.0)3.0 (1.6–5.8)N(%) patients with≥3 subchondral bone fatty lesions11/95(11.6%)29 (29%)0.0040.29 (0.2–0.4)0.88 (0.8–0.9)2.5 (1.3–4.7)N(%) patients with≥5 subchondral bone erosions or fatty lesions)13/95(13.7%)33 (33%)0.0020.33 (0.2–0.4)0.9 (0.8–0.9)2.4 (1.4–4.3)MRI spineN(%) patients with at least one structural lesion49 (50.0%)42/99(42.4%)NS0.4 (0.3–0.5)...