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Follow-up results of 702 patients receiving tumor necrosis factor-alpha antagonists and evaluation of risk of tuberculosis
Rheumatology International, 10/26/09

Cagatay T et al. – Diagnostic accuracy of TST for detecting latent tuberculosis is high among patients with inflammatory diseases even in the setting of immunosuppression. The risk of development of active TB is increased in this group of patients despite chemoprophylaxis, but this risk remains within the acceptable limits even in a moderate-tuberculosis incidence country, if proper chemoprophylaxis regimen is adhered.

Methods

702 patients with different inflammatory diseases receiving TNF-&alpha antagonists followed up from August 2005 to July 2008 at our department of chest disease
All patients had tuberculin skin test (TST) and postero-anterior chest radiograph (CXR) prior to anti TNF-&alpha antagonist treatment
All patients with TST result ≥ 5 mm or fibrotic lesions on CXR were administered chemoprophylaxis with isoniazid (INH) for 9 months

Results

6 patients developed active tuberculosis (4 pulmonary and 2 extrapulmonary) during follow-up period
TST found positive in 434 (61.8%) of patients
Patients, who were already on immunosuppressive therapy and who were not, were compared for difference in their TST results and no statistically significant difference was found
Chemoprophylaxis administered overall to 583 (83.0%) patients among which 31 (5.3%) developed hepatotoxicity
Of patients who developed active tuberculosis, all were decided to receive INH chemoprophylaxis

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