Therapeutic issues with, and long-term outcomes of, pulmonary mycobacterial tuberculosis treatment in patients with autoimmune rheumatic diseases

Abstract

Background: Real-world data on treatment safety and outcome of pulmonary tuberculosis (PTB) in patients with rheumatic diseases (RDs) are scarce. This study explored the therapeutic issues of standard first-line anti-tuberculosis (TB) medication in patients in whom PTB complicated autoimmune RDs.Methods: Observational, retrospective study was conducted in an intermediate TB burden area, South Korea. We evaluated the safety profile of, and adherence to, standard first-line anti-TB medication in PTB patients with systemic RD and assessed the long-term treatment outcomes, up to 84 months after treatment completion. Results: We included 37 patients suffering from PTB with RD (case group) and 191 without RD (control group). Rheumatoid arthritis (RA) was the most common RD (24 PTB patients, 64.9%). The frequency of severe adverse drug reactions (ADRs) was significantly higher in the case group than in the control group (36.1% vs. 12.5%, P=0.003). Severe gastrointestinal problems were the most commonly observed ADRs, with a high frequency consistently noted in both groups. Changes in first-line anti-TB medication because of severe ADRs were significantly more frequent in the case group, compared with the control group (19.4% vs. 8.3%, P=0.046). No significant between-group difference was evident in terms of long-term unfavorable outcomes (including relapse and mortality) (5.7% cases vs. 1.2% controls, P=0.146). Conclusions: Clinicians may encounter difficulties when treating PTB in patients with RD. Despite the favorable long-term outcomes of RD patients, the outcomes of individual patients such as those with systemic lupus erythematosus (SLE) should be interpreted with caution during post-therapy follow-up.

Prevalence and risk factors of active tuberculosis in patients with rheumatic diseases: a multi-center, cross-sectional study in China

“…Secondly, the risk factors of ATB in rheumatic patients not receiving anti-TNF treatment are unclear. Given the medical resource constraint and the fact that anti-TB therapy may induce severe adverse drug reactions when combined with rheumatic diseases [ 11 ], TB preventive treatment for all rheumatic patients may not be an optimal option. Identifying risk factors offer doctors reliable information in assessing the risk of ATB in patients with rheumatic diseases, which can greatly facilitate the generation of efficient prevention strategies based on clinical individualized risk assessment.…”

Simultaneous Systemic Lupus Erythematosus Flare and Disseminated Tuberculosis: Balancing Anti-Mycobacterial and Autoimmune Treatments

“…In the presence of active TB in patients with SLE or other rheumatic diseases, treatment follows the same recommendations for combination therapy as in other patients, with a preference for initial intensive treatment with quadruple therapy for at least two months, followed by at least four months of double therapy with isoniazid plus rifampicin and/or ethambutol. This treatment phase can be extended for three to six months among patients with diabetes, those with radiographic cavities, extensive extrapulmonary diseases, or in those who remain smear- or culture-positive at the end of the intensive phase [ 17 , 18 ]. Biological treatments should be suspended for at least six months when possible [ 15 ].…”

Incidence and risk factors of tuberculosis in systemic lupus erythematosus patients: a multi-center prospective cohort study

“…TB preventive treatment (TPT) can reduce the risk of ATB by about 70% ( 12 ), but its common adverse reactions such as liver toxicity should not be ignored ( 13 ). The proportion of adverse reactions of anti-TB drugs in patients with rheumatic immune diseases was as high as 36%, and 19.4% of the patients had to discontinue or change medications due to severe adverse reactions ( 14 ). Concomitant medication is an independent risk factor for adverse reactions of TPT ( 15 ).…”