The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan

Lim, Chong Hong; Chen, Hsin‐Hua; Chen, Yi Hsing; Chen, Der Yuan; Huang, Wen Nan; Tsai, Jaw Ji; Hsieh, Tsu‐Yi; Hsieh, Chang‐Wei; Hung, Wei Ting; Lin, Ching Tsai; Lai, Kuo-Lung; Tang, Kuo‐Tung; Tseng, Chih‐Wei

doi:10.1371/journal.pone.0178035

Cited by 56 publications

(46 citation statements)

References 28 publications

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“…Because of the use of immunosuppressive therapy, patients with IBD are at higher risk of active TB infection than the general population . Extrapulmonary TB is more common in patients on immunosuppressive agents, compared with the general population (30% vs 13%, in Taiwan, respectively) . Atypical presentation and disseminated disease is also more common in patients treated with anti‐TNF, making diagnosis more difficult .…”

Section: Resultsmentioning

confidence: 99%

“…171 Extrapulmonary TB is more common in patients on immunosuppressive agents, compared with the general population (30% vs 13%, in Taiwan, respectively). [174][175][176] Atypical presentation and disseminated disease is also more common in patients treated with anti-TNF, making diagnosis more difficult. 171 In Taiwan, 5.8% of cases of extrapulmonary TB were reported to have occurred in the gastrointestinal tract.…”

Section: Statement 27mentioning

confidence: 99%

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Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia

Ooi

Hilmi

Banerjee

et al. 2019

J of Gastro and Hepatol

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The Asia–Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, under the auspices of the Asia–Pacific Association of Gastroenterology with the goal of improving inflammatory bowel disease care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in conjunction with conventional treatments for ulcerative colitis and Crohn's disease in Asia. These statements also address how pharmacogenetics influences the treatments of ulcerative colitis and Crohn's disease and provides guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of inflammatory bowel disease workgroup employing the modified Delphi process. These statements do not intend to be all‐encompassing, and future revisions are likely as new data continue to emerge.

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Section: Resultsmentioning

confidence: 99%

Section: Statement 27mentioning

confidence: 99%

Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia

Ooi

Hilmi

Banerjee

et al. 2019

J of Gastro and Hepatol

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“…One systematic review of HBV reactivation in RA patients receiving TNF-alpha inhibitors reported that adalimumab carried a higher risk of HBV reactivation than etanercept (4.6% vs. 3.9%, respectively). The risk of tuberculosis is also higher in patients treated with adalimumab than in those treated with etanercept 5 . This difference may result from the weaker induction by etanercept of complement-dependent cytotoxicity on membrane-bound TNF-alpha-expressing cells 27 .…”

Section: Discussionmentioning

confidence: 99%

“…The use of bDMARDs targeting key components of the immune system can effectively inhibit the pathologic inflammation cascade that causes RA symptoms and subsequent joint destruction 2 . However, treatment with bDMARDs makes patients more susceptible to bacterial infections and potential reactivation of viral infections, such as hepatitis B or C, herpes, and varicella zoster [3][4][5] .…”

mentioning

confidence: 99%

Moderate Risk of Hepatitis B Virus Reactivation in HBsAg−/HBcAb+ Carriers Receiving Rituximab for Rheumatoid Arthritis

Kuo

Tseng

Lee

et al. 2020

Sci Rep

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to investigate the incidence and risk factors of hepatitis B virus (HBV) reactivation in HBV surface antigen (HBsAg) − / HBV core antibody (HBcAb) + patients who underwent rituximab (RtX) therapy for rheumatoid arthritis (RA). From January 2000 through December 2017, a total of 134 RA patients with various HBV serostatuses who received RTX at Dalin Tzu Chi Hospital were screened. Finally, 50 HBsAg − /HBcAb + patients were enrolled in this retrospective study. Baseline characteristics, comedications, and the occurrence of HBV reactivation were recorded. Four HBsAg − /HBcAb + RA patients (8%; 4/50) experienced HBV reactivation after treatment with RTX. Hepatitis flare-up occurred in 2 of these 4 patients, with a fatal outcome in one. HBV reactivation occurred approximately 1-4 years after the first dose of RTX and 0.5-1.5 years after the last one. In HBsAg − /HBcAb + patients, HBV reactivation was significantly more common in those who were HBV surface antibody (HBsAb) − at baseline than in those who were HBsAb + (30% vs 4%; p = 0.02). A history of adalimumab use was associated with HBV reactivation (100% vs 39%; p = 0.02). A moderate risk of HBV reactivation was observed in HBsAg − /HBcAb + RA patients receiving RtX therapy. the reactivation may induce acute hepatitis and even death. To reduce the risk of HBV reactivation, regular monitoring of liver function is insufficient; monitoring of viral load and HBsAg or prophylaxis with antiviral therapy should be considered.

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“…Impaired recruitment of CD4 + T cells may enhance the reactivation of TB in the elderly LTBI subjects. Indeed, a significant higher frequency of TB reactivation was recorded in patients >65 year-old (HR: 2.72, 95% CI: 1.06-6.99, p = 0.037) [118]. However, no age-related differences were found in the Northern California registry [119].…”

Section: Comorbidities and Increased Risk Of Tb Reactivationmentioning

confidence: 91%

Preventive therapy for tuberculosis in rheumatological patients undergoing therapy with biological drugs

Goletti

Petrone

Ippolito

et al. 2018

Expert Review of Anti-infective Therapy

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Latent tuberculosis infection (LTBI) accounts for almost a quarter of the world population, and, in 5-10% of the subjects with impaired immune-response against M. tuberculosis growth, it may progress to active tuberculosis (TB). In this review, we focus on the need to propose a screening for LTBI including preventive therapy offer in rheumatic patients undergoing therapy with biological drugs. Areas covered: We report on evidence that biologics are associated with an increased risk of active TB reactivation. This effect seems to be mainly limited to treatment with anti-tumor necrosis factor (TNF) agents, while non-anti-TNF-targeted biologics are not likely associated to any increased risk. We introduce the concept that the patients' coexisting host-related risk factors, such as comorbidities, are crucial to identify those at higher risk to reactivate TB. We report that preventive TB therapy is well tolerated in patients treated with biological drugs. Expert commentary: Availability of non-anti-TNF targeted biologics, that are not associated with an increased risk of TB reactivation, offers a great opportunity to tailor a therapeutic intervention at low/absent TB risk. After proper LTBI screening investigations, preventive TB therapy has been demonstrated to be effective and well-tolerated to reduce the risk of TB reactivation in rheumatic patients requiring biological drugs.

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The risk of tuberculosis disease in rheumatoid arthritis patients on biologics and targeted therapy: A 15-year real world experience in Taiwan

Cited by 56 publications

References 28 publications

Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia

Best practices on immunomodulators and biologic agents for ulcerative colitis and Crohn's disease in Asia

Moderate Risk of Hepatitis B Virus Reactivation in HBsAg−/HBcAb+ Carriers Receiving Rituximab for Rheumatoid Arthritis

Preventive therapy for tuberculosis in rheumatological patients undergoing therapy with biological drugs

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