Latent Tuberculosis Screening and Treatment in Rheumatoid Arthritis Patients Eligible for Anti-TNF Therapy in Endemic Areas: Does It Work?
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conferenceObject
Data de publicação
2012
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Editora
WILEY-BLACKWELL
Citação
ARTHRITIS AND RHEUMATISM, v.64, n.10, suppl.S, p.S75-S75, 2012
Resumo
Background/Purpose: Background: Current recommendations for latent tuberculosis infection (LTB) screening and treatment in patients eligible for anti-TNF agents are not well established in endemic regions. Thus, the aim of this study is to evaluate the long-term efficacy of LTB screening and treatment in RA patients under TNF blockers tight control therapeutic strategy Methods: Two hundred and two RA patients (1987 criteria) eligible for anti-TNF agents were initially screened for LTB by PPD test, chest X-ray and history of contact. Two hundred and nine patients receiving traditional DMARDs comprised the control group. Patients and controls were regularly followed at 1–3 months interval, from January 2007 to December 2011. During the study period, PPD was repeated in patients with TB clinical suspicion or due to extended ( 12 months) interruption/re-start of biologic treatment. Results: 202 patients were treated with anti-TNF blockers, 85(42%) with one agent and 117(58%) with two or more: 181 received infliximab, 93 adalimumab and 75 etanercept. LTB screening (PPD and/or history of contact and/or X-ray) was positive in 69(34%) patients. In 65%(45 patients) PPD was positive, 36%(n 25) had history of contact and 21%(n 15) with X-ray alterations. Of note, in the 24 LTB patients with negative PPD, contact history accounted for 75% and X-ray for 37% of the positive screened cases. LTB treatment with isoniazid during 6 months was administered to all positive screened patients and none developed TB during follow-up. Regarding the 133 remaining screening negative patients none had TB during the first twelve months of anti-TNF therapy. PPD test was repeated in only 53 patients (26%) due to interruption/re-start of biologic treatment (51cases) or clinical TB suspicion (2 cases). PPD turned out to be positive in five patients: three that received LTB treatment and the two patients with clinical TB suspicion, both diagnosed as active TB (after 14 and 36 months of anti-TNF treatment) and properly treated with standard TB treatment. In those RA patients under traditional DMARDs, three cases (1.5%) of active TB were observed. Thus, the frequency of TB in RA patients during five years of observation was similar in patients under biological and traditional DMARDs (1% vs. 1.5%, p 0.68), although higher than the expected for the area (60/100,000/ per year). Conclusion: The present study provided evidence that the recommended screening and treatment protocol for LTB in patients under anti-TNF treatment was also efficient in endemic areas, with a special attention to contact history in those with negative PPD. Active TB diagnosis during anti-TNF treatment seems not to be related to screening failure, reinforcing the importance of constant clinical surveillance.