Evaluation of long-term effect of tuberculosis chemoprophylaxis in patients using anti tumor necrosis factor alpha agents

Abstract

Introduction and Aim: There is an increased risk of tuberculosis (TB) in patients with rheumatoid diseases(RD) treated with anti TNF alpha agents. Screening and, if necessary, chemoprophylaxis is recommended in patients undergoing anti TNF alpha treatment. This study aimed to determine the incidence of active TB due to long term anti TNF alpha usage in patients with RD and to evaluate the effectiveness of tuberculosis chemoprophylaxis regimen. Materials and Methods: Patients treated with anti TNF alpha agents for more than 5 years with RDs were evaluated retrospectively. Demographic and clinical characteristics, use of chemoprophylaxis, laboratory tests before and after anti TNF alpha treatment and development of TB were examined. Results: A total of 150 patients (79 male [52.7%], 71 female [47.3%]) with a mean age of 45±13 years were evaluated. The tuberculosis rate over 5 years follow up was found as 1.3%. One male developed pulmonary TB 5 years and 1 female developed miliary TB 10 years after the beginning of anti-TNF alpha therapy despite chemoprophylaxis with isoniazid. The mean number of neutrophiles and lymphocytes were significantly decreased after treatment(p<0.05). Conclusion: In an RD patient without latent TB, the risk of TB should be kept in mind even after 10 years. Regular monitoring should be considered for long term TNF antagonist therapy.

Keywords

• Anti TNF alpha
• tuberculosis
• chemoprophylaxis
• long term effect

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