Risk of tuberculosis among Alabama children and adolescents treated with tumor necrosis factor inhibitors: a retrospective study

Abstract

BackgroundTumor Necrosis Factor inhibitors (TNFi) have dramatically improved the outlook for patients with inflammatory arthritides and bowel disease (IBD), but are associated with increased infection risks, including tuberculosis (TB). Pediatric inflammatory diseases are uncommon, and the risk of TB in children taking TNFi remains unclear. The objective of this study was to report the incidence of TB disease among TNFi recipients at a single pediatric medical center serving most of Alabama compared to that of the general population of Alabama children.MethodsInstances of TNFi usage among patients under age 20 years from July 1, 2007 through April 17, 2015 were captured from electronic health records at Children’s of Alabama (CoA), which has the only pediatric rheumatology clinic in Alabama, and where a substantial number of children in Alabama with inflammatory bowel disease receive care., and reports of TB cases were obtained from the Alabama Department of Public Health (ADPH). Incidence was expressed as TB cases/10,000 person-years, using population estimates from the Alabama Center for Health Statistics.Results1033 Alabama patients at CoA who were residents of Alabama were identified who received TNFi for a total of 1564 person-years. One adolescent on TNFi developed severe extrapulmonary TB (incidence density = 6.4 per 10,000; 95% CI 0.9–45.4 per 10,000). Sixty-three cases occurred in persons not on TNFi (incidence density = 0.064 per 10,000; 95% CI 0.050–0.082 per 10,000).ConclusionsOne case of TB disease among TNFi-exposed children was identified for 1564 person-years in Alabama residents. Although rare, this is higher than expected relative to the general rate of TB in Alabama. Thus, continued diagnostic vigilance for TB in children taking TNFi is required.Trial registration numberNot applicable.

Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study

“…Our study highlights the great severity of TB disease in children on anti-TNF-α therapy, consistent with previous case reports [10,[13][14][15][16]. All patients captured by our study presented with severe disease.…”

“…To our knowledge, fewer than 20 cases have been described in detail in the peer-reviewed literature so far [10][11][12][13][14][15][16]. Concerningly, several of those cases had a fatal outcome.…”

<p>Herpes Zoster, Hepatitis C, and Tuberculosis Risk with Apremilast Compared to Biologics, DMARDs and Corticosteroids to Treat Psoriasis and Psoriatic Arthritis</p>

“…Few studies have been conducted since the implementation of tuberculosis screening to assess the incidence of tuberculosis among patients with rheumatoid arthritis, psoriasis or PsA. [24][25][26]29 We found a few cases of patients with treated tuberculosis in our cohort, four of whom were exposed to apremilast. The IRs for treated tuberculosis among users of DMARDs and biologics in our study fall within the range previously reported.…”

Tuberkulose bei Kindern und Jugendlichen unter Therapie mit TNF-α-Inhibitoren

“…Zu Kindern und Jugendlichen liegen einzelne Fallberichte oder Ergebnisse kleiner Kohortenstudien vor, die auch über schwere und zum Teil letale Verläufe einer Tuberkulose unter einer Anti-TNF-a-Therapie berichteten 22 – 25 . Die bisher größte Studie zu dem Thema der TNF-α-assoziierten Tuberkulose bei Kindern und Jugendlichen wurde kürzlich von der Paediatric Network European Trials Group (ptbnet), einem Netzwerk von Pädiatern, die in Europa im Bereich der Kindertuberkulose mit dem Fokus auf klinische Forschungsprojekte kooperieren, veröffentlicht 26 .…”