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Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: Results from the British Society for Rheumatology Biologics Register (BSRBR)
Annals of Rheumatic Diseases, 11/10/09

Dixon WG et al. – The rate of TB in patients with RA treated with anti-TNF therapy was 3-4 fold higher in patients receiving INF and ADA compared to ETA.

• National prospective observational study
• Compared TB rates in 10712 anti-TNF treated patients (3913 ETA, 3295 INF, 3504 ADA) and 3232 patients with active RA treated with traditional disease-modifying anti-rheumatic drugs

• To April 2008, 40 cases of TB reported, all in the anti-TNF cohort
• Rate of TB higher for monoclonal antibodies ADA (144 events/ 100,000 person years (pyrs)) and INF (136/100,000 pyrs) than ETA (39/ 100,000 pyrs)
• After adjustment, incidence rate ratio compared to ETA-treated patients was 3.1 (95% CI 1.0, 9.5) for INF and 4.2 (1.4, 12.4) for ADA
• Median time to event lowest for INF (5.5 mos) compared to ETA (13 months) and ADA (18.5 mos)
• 13/40 cases occurred after stopping therapy
• 25/40 (62%) cases were extra-pulmonary, of which 11 were disseminated
• Patients of non-white ethnicity had six-fold increased risk of TB compared to white patients treated with anti-TNF therapy

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