Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists

Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in... Objective To investigate the impact of official recommendations regarding the management of latent tuberculosis (TB) infection on the rate of active TB in patients receiving treatment with tumor necrosis factor (TNF) antagonists. Methods Data on active TB rates and on screening and treatment of latent TB infection were extracted from the BIOBADASER (Spanish Society of Rheumatology Database on Biologic Products), a registry of patients with rheumatic conditions treated with TNF antagonists. The rates of active TB among the BIOBADASER patients were compared with those in the background Spanish population, and BIOBADASER patients with rheumatoid arthritis (RA) were compared with a cohort of RA patients from the EMECAR (Morbidity and Clinical Expression of Rheumatoid Arthritis) study who were not treated with TNF antagonists and were followed up for 5 years. Results Active TB developed in 34 patients, of whom 32 started taking TNF antagonists prior to the official recommendations on latent TB infection (pre‐OR) and 2 began treatment after the recommendations were issued (post‐OR). All cases of TB occurred during treatment with infliximab, and 28 of these patients had RA. Pre‐OR, the active TB rate in BIOBADASER patients was 20.9‐fold higher than in the background Spanish population, while RA patients in the BIOBADASER had rates 22.6‐ and 6.2‐fold higher than the background and EMECAR populations, respectively. Post‐OR, 324 patients with a tuberculin skin test result ≥5 mm and/or chest radiograph findings suggestive of past TB were treated for 9 months with isoniazid (INH). Post‐OR, active TB rates among the BIOBADASER patients decreased by 78% (incidence risk ratio (IRR) 0.22, 95% confidence interval (95% CI) 0.03–0.88; P = 0.008), while among RA patients in the BIOBADASER, the rate dropped by 83% and reached the EMECAR rate (IRR 1.0, 95% CI 0.02–8.2). There were no INH treatment–related hospitalizations or deaths. Conclusion Strategies to treat latent TB infection that are tailored to the at‐risk population can effectively and safely lessen the likelihood of active TB in patients treated with TNF antagonists. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Arthritis & Rheumatism Wiley

Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists

Loading next page...
 
/lp/wiley/effectiveness-of-recommendations-to-prevent-reactivation-of-latent-9OSnEuo7Bu

References (22)

Publisher
Wiley
Copyright
Copyright © 2005 by the American College of Rheumatology
ISSN
0004-3591
eISSN
1529-0131
DOI
10.1002/art.21043
pmid
15934089
Publisher site
See Article on Publisher Site

Abstract

Objective To investigate the impact of official recommendations regarding the management of latent tuberculosis (TB) infection on the rate of active TB in patients receiving treatment with tumor necrosis factor (TNF) antagonists. Methods Data on active TB rates and on screening and treatment of latent TB infection were extracted from the BIOBADASER (Spanish Society of Rheumatology Database on Biologic Products), a registry of patients with rheumatic conditions treated with TNF antagonists. The rates of active TB among the BIOBADASER patients were compared with those in the background Spanish population, and BIOBADASER patients with rheumatoid arthritis (RA) were compared with a cohort of RA patients from the EMECAR (Morbidity and Clinical Expression of Rheumatoid Arthritis) study who were not treated with TNF antagonists and were followed up for 5 years. Results Active TB developed in 34 patients, of whom 32 started taking TNF antagonists prior to the official recommendations on latent TB infection (pre‐OR) and 2 began treatment after the recommendations were issued (post‐OR). All cases of TB occurred during treatment with infliximab, and 28 of these patients had RA. Pre‐OR, the active TB rate in BIOBADASER patients was 20.9‐fold higher than in the background Spanish population, while RA patients in the BIOBADASER had rates 22.6‐ and 6.2‐fold higher than the background and EMECAR populations, respectively. Post‐OR, 324 patients with a tuberculin skin test result ≥5 mm and/or chest radiograph findings suggestive of past TB were treated for 9 months with isoniazid (INH). Post‐OR, active TB rates among the BIOBADASER patients decreased by 78% (incidence risk ratio (IRR) 0.22, 95% confidence interval (95% CI) 0.03–0.88; P = 0.008), while among RA patients in the BIOBADASER, the rate dropped by 83% and reached the EMECAR rate (IRR 1.0, 95% CI 0.02–8.2). There were no INH treatment–related hospitalizations or deaths. Conclusion Strategies to treat latent TB infection that are tailored to the at‐risk population can effectively and safely lessen the likelihood of active TB in patients treated with TNF antagonists.

Journal

Arthritis & RheumatismWiley

Published: Jun 1, 2005

There are no references for this article.