Tuberculosis in people with rheumatic disease in Finland 1995–2007: a nationwide retrospective register study

Vuorela, Marjo; Mars, Nina; Salonen, Jarmo S.; Kauppi, M.

doi:10.1093/rap/rkz020

Cited by 11 publications

(11 citation statements)

References 32 publications

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“…In a nationwide retrospective register study performed in Finland, it was noted that between 1995 and 2007 the incidence of TB in adult RD patients with reimbursed DMARDs decreased from 58.8 to 30.0 per 100,000. This trend was similar to that in the general population and was explained by an improved standard of living and by strict TB control during the 20th century [13].…”

Section: Discussionsupporting

confidence: 77%

“…This risk is probably associated with immunosuppression linked to the disease and the use of other medications such as corticosteroids [4,6,7,12]. Studies from Sweden and Finland (countries with a low incidence of TB) found that compared with the general population, even rheumatic patients not treated with biologicals had a fourfold increased risk of TB [6,13]. Studies suggest that the incidence of development of TB should be even more considerable in patients who live in countries with a high incidence of this infection in the general population [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

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Incidence of Tuberculosis in Inflammatory Rheumatic Diseases: Results from a Lithuanian Retrospective Cohort Study

et al. 2020

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Background and objective: With an increase in survival rates among rheumatic patients, comorbidities and infections, in particular, have gained more importance, especially after the introduction of biologicals to the treatment algorithms. Tuberculosis (TB) infection has always been given a special attention in patients with rheumatic diseases (RD). Although Lithuanian population has one of the highest TB incidence rates among European countries, the incidence of TB in the rheumatic patients’ population is still unknown. The aim of this study was to assess the incidence rate of TB in an inflammatory RD retrospective cohort and to compare that rate with a rate in a general population. Methods: Patients with the first-time diagnosis of inflammatory RD during the period between 1 January 2012 and 31 December 2017 were identified from the Lithuanian Compulsory Health Insurance Information System database SVEIDRA. All cases were cross-checked with Health Information center at the Institute of Hygiene, for the vital status of these patients and date of death if the fact of death was documented, and with Tuberculosis Register operated by Vilnius University Hospital Santaros Klinikos, for the confirmation of TB cases. Sex and age standardized incidence ratios (SIR) were calculated by dividing the observed numbers of TB among rheumatic patients by the expected number of cases, calculated using national rates from Lithuanian Department of Statistics Official Statistics website. Results: Overall, 8779 patients with newly diagnosed RD were identified during the 2013–2017 period, these included 458 patients who used biological disease modifying drugs (bDMARDs). The mean duration of the follow-up period was 2.71 years. The cohort consisted mainly of women (70%) and a half of the cohort were rheumatoid arthritis (RA) patients (53%). Mean age of patients at the time of RD diagnosis was 56 years (range = 18–97 years). There were 9 TB cases identified during 23,800 person years of follow-up: 2 cases among them were treated with bDMARDs. The mean calculated annual TB incidence in RD cohort was 37.81 per 100,000 person years, which is consistent with the incidence rate predicted by national estimates, with a resultant SIR of 0.90 (0.41–1.70). The unadjusted hazard ratio for bDMARD use versus no bDMARD use was 4.54 (0.94; 21.87) in a total cohort and very similar in rheumatoid arthritis cohort; in both cohorts, it was not a statistically significant risk. Conclusions: Here, we present the first nationwide cohort study to assess the incidence of TB in a broad spectrum of inflammatory RD. Although limited by short follow-up period, this study shows that TB incidence in RD cohort does not exceed TB incidence in the general Lithuanian population.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Incidence of Tuberculosis in Inflammatory Rheumatic Diseases: Results from a Lithuanian Retrospective Cohort Study

et al. 2020

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“…In the present study, the number of patients with extrapulmonary TB was 8 (15.7%), which seems to be numerically similar to the proportion of extrapulmonary TB arising in immunocompetent subjects and is contradictory to the knowledge that patients under TNF-α inhibitors are more prone to extrapulmonary TB (40). In addition, even though the number of incident TB cases were not large, a recent publication by Chung et al reported that a proportion of extrapulmonary TB in patients with rheumatoid arthritis (RA) was 38.5% (41), and a study by Vuorela et al has shown that ∼23.9% of patients with rheumatic diseases are affected with extrapulmonary TB (42). Several factors could be accounted for the discrepant results between the previous studies and our study.…”

Section: Discussionmentioning

confidence: 96%

Incidence of Tuberculosis in Systemic Necrotizing Vasculitides: A Population-Based Study From an Intermediate-Burden Country

et al. 2020

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Objective: Tuberculosis (TB) has a significant impact on public health; however, its incidence in patients with systemic necrotizing vasculitides (SNV) remains unknown. Therefore, we evaluated the incidence of TB in patients with SNV using a nationwide claims database. Methods: The Health Insurance and Review Agency database was used to identify patients diagnosed with SNV between 2010 and 2018. The standardized incidence ratio (SIR) was calculated to compared the risk of TB between patients and the general population, based on the 2016 annual national TB report. The incidence of TB after SNV diagnosis was compared by estimating age-and sex-adjusted incidence rate ratio (IRR). A time-dependent Cox regression analysis was performed to estimate factors associated with TB. Results: Among the included 2,660 patients, 51 (1.9%) developed TB during the follow-up period. The risk of TB was significantly higher in patients with SNV [SIR 6.09, 95% confidence interval (CI) 4.53-8.00], both in men (SIR 5.95) and women (SIR 6.26), than in the general population; this increased risk was consistent in all disease subtypes, except eosinophilic granulomatosis with polyangiitis. Additionally, the incidence of TB was the highest in patients with SNV within the first 3 months after diagnosis (adjusted IRR: 8.90 compared to TB ≥ 12 months). In Cox regression analysis, the diagnosis of microscopic polyangiitis [hazard ratio (HR) 3.22, 95% CI 1.04-9.99], granulomatosis with polyangiitis (HR 4.63, 95% CI 1.53-14.02), and polyarteritis nodosa (HR 3.51, 95% CI 1.13-10.88) were independent factors associated with TB. Conclusion: Even when considering the high incidence of TB in the geographic region, the risk of TB increased in patients with SNV, with a difference based on disease subtypes. Moreover, taking into account of the high Ahn et al. TB in SNV incidence of TB in SNV, vigilant monitoring for TB is required especially during the early disease period.

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“…In 2016, 6.3 million new cases of TB and 1.3 million cases of TB-related death were reported among human immunodeficiency virus (HIV)-negative patients [ 1 ]. Although its incidence has been slowly decreasing since 2002, it is still a significant co-morbidity in patients with rheumatic diseases because the immunosuppressive agents used to treat rheumatic diseases increase the risk of TB [ 2 ]. Among the various immunosuppressive agents, high-dose glucocorticoids, a mainstay of the treatment of many rheumatic diseases, are particularly known to increase the TB risk [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Risk-benefit analysis of isoniazid monotherapy to prevent tuberculosis in patients with rheumatic diseases exposed to prolonged, high-dose glucocorticoids

Curtis

Lee

et al. 2020

PLoS ONE

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Objective To investigate the incidence of tuberculosis (TB) in patients with rheumatic diseases receiving high-dose glucocorticoids and to evaluate the preventive effect of isoniazid (INH). Methods This study included 1618 treatment episodes of prolonged (≥4 weeks), high-dose steroids (≥30mg/day of prednisone) in 1160 patients. Of these, INH was administered in 152 (9.4%) treatment episodes (INH group), while others received no prophylaxis (control group). The high-risk subgroup (n = 92) was defined as patients with 1) incomplete adherence to treatment of previous TB, 2) positive interferon-γ release assay, and/or 3) linear/reticular fibrotic lesions on chest radiographs. Primary outcome was 1-year incidence of TB in each group. Results During 1579.8 person-years, 21 cases of TB occurred. The high-risk subgroup showed a significantly higher TB incidence than the non-high-risk subgroup (Incidence rate ratio = 8.29). INH did not significantly affect the 1-year TB incidence in the whole population but numerically reduced it only in the high-risk subgroup [adjusted hazards ratio = 0.37 (95% CI, 0.002–5.10)]. The incidence of adverse drug reactions (ADRs) related to INH was 111.6 (89.3–137.9)/100 person-years, including one fatal occurrence of fulminant hepatitis. The number needed to treat (NNT) to prevent one case of TB was lower than the number needed to harm (NNH) for one case of severe ADR only in the high-risk subgroup (11 vs. 16). Conclusion INH treatment to prevent TB might be effective in high-risk patients but has a risk of frequent ADRs, which limits its use in general practice in patients not at a high risk of developing TB.

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Tuberculosis in people with rheumatic disease in Finland 1995–2007: a nationwide retrospective register study

Cited by 11 publications

References 32 publications

Incidence of Tuberculosis in Inflammatory Rheumatic Diseases: Results from a Lithuanian Retrospective Cohort Study

Incidence of Tuberculosis in Inflammatory Rheumatic Diseases: Results from a Lithuanian Retrospective Cohort Study

Incidence of Tuberculosis in Systemic Necrotizing Vasculitides: A Population-Based Study From an Intermediate-Burden Country

Risk-benefit analysis of isoniazid monotherapy to prevent tuberculosis in patients with rheumatic diseases exposed to prolonged, high-dose glucocorticoids

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