Treatment with anti-tumor necrosis factor (TNF) agents is recognized as a risk factor for tuberculosis (TB) in patients with immune-mediated inflammatory diseases such as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, psoriatic arthritis and psoriasis. Most TB cases develop as a result of reactivation of a latent TB infection, and health authorities worldwide recommend screening for latent TB and treating patients before initiating anti-TNF treatment. A new study examined cases of TB associated with anti-TNF therapy and found that the risk of TB is higher for patients receiving anti-TNF monoclonal antibody therapy (infliximab or adalimumab) than for those receiving soluble TNF receptor therapy (etanercept). The study is published in the July issue of Arthritis & Rheumatism.
Led by Xavier Mariette of the Université Paris-Sud, researchers set up a national registry in France to collect all cases of TB occurring during a three-year period in patients receiving anti-TNF therapy for any reason. Researchers collected data on 69 cases of TB, assessing risk factors for TB before anti-TNF therapy began and anti-TNF treatment history.
The results showed that the risk of TB for patients receiving anti-TNF therapy compared with the French population differed depending on the anti-TNF agent used; those receiving monoclonal anti-TNF therapy had a higher risk than those receiving sTNFR therapy. The risk of TB was higher during the first year of anti-TNF treatment, which favored the reactivation of latent TB. None of the patients who received correct prophylactic treatment for TB which is in France in most of the cases the association of INH and rifampicione for three months. Two-thirds of TB cases occurred in patients with negative skin tests.
