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Biyolojik ajan kullanan çocuklarda tüberküloz sıklığının değerlendirilmesi

Yıl 2023, Cilt: 16 Sayı: 2, 238 - 246, 05.04.2023
https://doi.org/10.31362/patd.1189676

Öz

Amaç: Anti-TNF ilaçlar tüberküloz enfeksiyon riskini arttırırlar. Bu çalışmayla Anti-TNF ilaç kullanan hastalarda, tüberküloz gelişme sıklığını araştırmayı amaçladık.
Gereç ve yöntem: Çalışmaya anti-TNF ilaç kullanan 115 çocuk hasta dahil edildi. Olguların klinik ve epidemiyolojik özellikleri retrospektif olarak değerlendirildi.
Bulgular: Anti-TNF ilaç kullanan 115 olgu çalışmaya dahil edildi. Olguların tanıları; Juvenil Romatoid Artrit 76 (%66), Ülseratif Kolit 11 (%9,6), Crohn's 7 (%6), Ankilozan Spondilit 6 (%5,2), FMF 5 (%4,3), Psoriasis 4 (%3,5) şeklindeydi. Hastaların kullandığı ajanların dağılımı ise; etanersept 74 (%64,3), infliximab 17 (%14,8), adalimumab 17 (%14,8), anakinra 5 (%4,3) ve kanakinumab 2 (%1,7) şeklindeydi. Tüm vakaların iki aylıkken BCG aşısı olduğu öğrenildi, aşı kartları ve sağlık bakanlığının aşı takip sisteminden teyit edildi. Tüm olgulara TDT yapıldı ve TDT yanıtı <5mm 89 (%77,4), 5-9 mm 11 (%8,7), 10-14 mm 8 (%7,4), >15 mm 7 (%5,6) olarak ölçüldü. Latent tüberküloz tanısı alan 17 olguya 9 ay izoniazid (INH) profilaksisi başlandı. Olguların hiçbirinde aktif tüberküloz saptanmadı.
Sonuç: Anti-TNF alan tüm hastaların tüberküloz açısından değerlendirilmesi gerekmektedir. Tedavi başlangıcında saptanmasa da tedavi süresince güncel kılavuzlar ışığında temas öyküsü, semptomlar, fizik muayene, akciğer grafisi ve TDT/IGRA ile düzenli tüberküloz taramasına devam edilmelidir.

Kaynakça

  • 1. Tracey D, Klareskog L, Sasso EH, Salfeld JG, Tak PP. Tumor necrosis factor antagonist mechanisms of action: a comprehensive review. Pharmacol Ther. 2008 Feb;117(2):244-79.
  • 2. Philips JA, Ernst JD. Tuberculosis pathogenesis and immunity. AnnuRev Pathol. 2012; 7:353-84. 9. Raychaudhuri S. P., Nguyen C. T., Raychaudhuri S. K., Gershwin M. E. Incidence and nature of infectious disease in patients treated with anti-TNF agents. Autoimmun Rev. 2009;9(2):67-81.
  • 3. Wallis R. S., Broder M. S., Wong J. Y., Hanson M. E., Beenhouwer D. O. Granulomatous infectious diseases associated with tumor necrosis factor antagonists. Clin Infect Dis. 2004;38(9):1261-1265.
  • 4. Wallis RS. J Investig Dermatol Symp Proc. 2007 May; 12(1):16-21 doi: 10.1038/sj.jjdsymp.5650031
  • 5. Taylor PC. Tumor necrosis factor-blocking therapies. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, editors. Rheumatology. 5th ed. Philadelphia, PA: Mosby, Elsevier; 2015:492–510.
  • 6. Caso F, Costa L, Del Puente A, et al. Pharmacological treatment of spondyloarthritis: exploring the effectiveness of nonsteroidal anti-inflammatory drugs, traditional disease-modifying antirheumatic drugs and biological therapies. Ther Adv Chronic Dis 2015; 6:328–38.
  • 7. Ungprasert P, Thongprayoon C, Davis JM, et al. 3rd. Indirect comparisons of the efficacy of biological agents in patients with psoriatic arthritis with an inadequate response to traditional disease-modifying anti-rheumatic drugs or to non-steroidal anti-inflammatory drugs: a meta-analysis. Semin Arthritis Rheum 2016; 45:428–38.
  • 8. Steigerwald KA, Ilowite NT. Novel treatment options for juvenile idiopathic arthritis. Expert Rev Clin Pharmacol 2015; 8:559–73. 4.
  • 9. Turkish Ministry of Health, Public Health Institution of Turkey, Tuberculosis Guide for Patients Using Anti-TNF, Ankara, 2016.
  • 10. British Thoracic Society Standards of Care Committee. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. Thorax. 2005;60(10):800-805.
  • 11. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep. 2000;49(RR-6):1-51.
  • 12. Borekci, S., Atahan, E., Demir Yilmaz, D., Mazıcan, N., Duman, B., Ozguler, Y. et al. (2015). Factors affecting the tuberculosis risk in patients receiving anti-tumor necrosis factor-α treatment. Respiration; international review of thoracic diseases, 2015;90(3), 191–198.
  • 13. Kilic O, Kasapcopur O, Camcioglu Y, Cokugras H, Arisoy N, Akcakaya N. Is it safe to use anti-TNF-α agents for tuberculosis in children suffering with chronic rheumatic disease? Rheumatol Int. 2012 Sep;32(9):2675-9. doi: 10.1007/s00296-011-2030-8. Epub 2011 Jul 26. PMID: 21789614.
  • 14. Girit S, Ayzit Atabek A, Şenol E, KoÇkar Kizilirmak T, Pekcan S, GÖktaŞ Ş, Öktem S, KasapÇopur Ö, ÇokuĞraŞ H. Screening for Latent Tuberculosis in Children With Immune-mediated Inflammatory Diseases Treated With Anti-tumor Necrosis Factor Therapy: Comparison of Tuberculin Skin and T-SPOT Tuberculosis Tests. Arch Rheumatol. 2019 Jun 25;35(1):20-28. doi: 10.5606/ArchRheumatol.2020.7294. PMID: 32637916; PMCID: PMC7322294.
  • 15. Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis 2017;64:e1-e33.
  • 16. Solovic I, Sester M, Gomez-Reino JJ, Rieder HL, Ehlers S, Milburn HJ, et al. The risk of tuberculosis related to tumour necrosis factor antagonist therapies: a TBNET consensus statement. Eur Respir J 2010;36:1185-206.
  • 17. Keser G, Direskeneli H, Akkoç M, et al. II. RAED ConsensusMeeting Report. May 7,2005, Izmir.
  • 18. Cagatay T, Aydin M, Sunmez S, et al. Follow-up results of 702 patients receiving tumor necrosis factor-alpha antagonistsand evaluation of risk of tuberculosis. Rheumatol Int2010;30:1459-63.
  • 19. Hanta I, Ozbek S, Kuleci S, Kocabas A. The evaluation of latent tuberculosis in rheumatologic diseases for anti TNFTherapy: Experience with 192 patients. Clin Rheumatol 2008;27:1083-6.
  • 20. Kurt, O. K., Kurt, B., Talay, F., Tug, T., Soy, M., Bes, C. et al. Intermediate to long-term follow-up results of INH chemoprophylaxis prior to anti-TNF-alpha therapy in a high-risk area for tuberculosis. Wien Klin Wochenschr. 2013;125(19-20):616-620.
  • 21. Kaptan, Y., Suner, A., Taş, M. N., Oksel, F., Aksu, K., Sayiner, A. Tuberculosis despite latent infection screening and treatment in patients receiving TNF inhibitor therapy. Clin Rheumatol. 2021;40(9):3783-3788.
  • 22. Noguera-Julian A, Calzada-Hernández J, Brinkmann F, et al. Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study. Clin Infect Dis. 2020 Dec 17;71(10):2561-2569. doi: 10.1093/cid/ciz1138. PMID: 31796965.
  • 23. Dixon, W. G., Hyrich, K. L., Watson, K. D. et al. Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (BSRBR). Ann Rheum Dis. 2010;69(3):522-528.
  • 24. Miller EA, Ernst JD. Anti-TNF immunotherapy and tuberculosis reactivation: another mechanismrevealed. J Clin Invest 2009; 119: 1079-1082.
  • 25. Bruns H, Meinken C, SchauenbergP, et al. Anti-TNF immunotherapy reduces CD8+ Tcell mediated antimicrobial activity against Mycobacterium Tuberculosis in humans. J Clin Invest 2009; 119: 11167-1177.
  • 26. Jolanta Paluch-Oleś, Agnieszka Magryś. Identification of latent tuberculosis infection in rheumatic patients under consideration for treatment with anti-TNF-α agents. Arch Med Sci 2013; 9, 1: 112-117

Evaluation of tuberculosis frequency in children using biological agents

Yıl 2023, Cilt: 16 Sayı: 2, 238 - 246, 05.04.2023
https://doi.org/10.31362/patd.1189676

Öz

Purpose: Anti-TNF drugs increase the risk of tuberculosis. In this study we aimed to investigate the incidence of tuberculosis in patients using anti-TNF drugs.
Methods: One hundred and fifteen pediatric cases which were received anti-TNF drugs were included in the study. The clinical and epidemiological characteristics of the cases were analyzed retrospectively.
Results: One hundred and fifteen cases using anti-TNF drugs were included in the study. The diagnoses of the cases were as follows; Juvenile Rheumatoid Arthritis 76 (66%), Ulcerative Colitis 11 (9.6%), Crohn's 7 (6%), Ankylosing Spondylitis 6 (5.2%), FMF 5 (4.3%), Psoriasis 4 (%3.5). The distribution of the agents used by the patients was; etanercept 74 (64.3%), infliximab 17 (14.8%), adalimumab 17 (14.8%), anakinra 5 (4.3%), and canakinumab 2 (%1.7). It was learned that all cases had BCG vaccinations when they were two months old, confirmed by the vaccination cards and the ministry of health's vaccination follow-up system. TST was performed in all of the cases and TST response was measured as <5mm in 89 (77.4%), 5-9 mm in 11 (8.7%), 10-14 mm in 8 (7.4%), >15 mm in 7 (5.6%) cases. Isoniazid (INH) prophylaxis was started for nine months in 17 cases with the diagnosis of latent tuberculosis. Active tuberculosis was not detected in any of the cases.
Conclusion: All patients receiving anti-TNF need to be evaluated for tuberculosis. Although it is not detected at the beginning of the treatment, regular tuberculosis screening should be continued during the treatment with contact history, symptoms, physical examination, chest X-ray, and TST/IGRA in light of current guidelines.


Kaynakça

  • 1. Tracey D, Klareskog L, Sasso EH, Salfeld JG, Tak PP. Tumor necrosis factor antagonist mechanisms of action: a comprehensive review. Pharmacol Ther. 2008 Feb;117(2):244-79.
  • 2. Philips JA, Ernst JD. Tuberculosis pathogenesis and immunity. AnnuRev Pathol. 2012; 7:353-84. 9. Raychaudhuri S. P., Nguyen C. T., Raychaudhuri S. K., Gershwin M. E. Incidence and nature of infectious disease in patients treated with anti-TNF agents. Autoimmun Rev. 2009;9(2):67-81.
  • 3. Wallis R. S., Broder M. S., Wong J. Y., Hanson M. E., Beenhouwer D. O. Granulomatous infectious diseases associated with tumor necrosis factor antagonists. Clin Infect Dis. 2004;38(9):1261-1265.
  • 4. Wallis RS. J Investig Dermatol Symp Proc. 2007 May; 12(1):16-21 doi: 10.1038/sj.jjdsymp.5650031
  • 5. Taylor PC. Tumor necrosis factor-blocking therapies. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, editors. Rheumatology. 5th ed. Philadelphia, PA: Mosby, Elsevier; 2015:492–510.
  • 6. Caso F, Costa L, Del Puente A, et al. Pharmacological treatment of spondyloarthritis: exploring the effectiveness of nonsteroidal anti-inflammatory drugs, traditional disease-modifying antirheumatic drugs and biological therapies. Ther Adv Chronic Dis 2015; 6:328–38.
  • 7. Ungprasert P, Thongprayoon C, Davis JM, et al. 3rd. Indirect comparisons of the efficacy of biological agents in patients with psoriatic arthritis with an inadequate response to traditional disease-modifying anti-rheumatic drugs or to non-steroidal anti-inflammatory drugs: a meta-analysis. Semin Arthritis Rheum 2016; 45:428–38.
  • 8. Steigerwald KA, Ilowite NT. Novel treatment options for juvenile idiopathic arthritis. Expert Rev Clin Pharmacol 2015; 8:559–73. 4.
  • 9. Turkish Ministry of Health, Public Health Institution of Turkey, Tuberculosis Guide for Patients Using Anti-TNF, Ankara, 2016.
  • 10. British Thoracic Society Standards of Care Committee. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. Thorax. 2005;60(10):800-805.
  • 11. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep. 2000;49(RR-6):1-51.
  • 12. Borekci, S., Atahan, E., Demir Yilmaz, D., Mazıcan, N., Duman, B., Ozguler, Y. et al. (2015). Factors affecting the tuberculosis risk in patients receiving anti-tumor necrosis factor-α treatment. Respiration; international review of thoracic diseases, 2015;90(3), 191–198.
  • 13. Kilic O, Kasapcopur O, Camcioglu Y, Cokugras H, Arisoy N, Akcakaya N. Is it safe to use anti-TNF-α agents for tuberculosis in children suffering with chronic rheumatic disease? Rheumatol Int. 2012 Sep;32(9):2675-9. doi: 10.1007/s00296-011-2030-8. Epub 2011 Jul 26. PMID: 21789614.
  • 14. Girit S, Ayzit Atabek A, Şenol E, KoÇkar Kizilirmak T, Pekcan S, GÖktaŞ Ş, Öktem S, KasapÇopur Ö, ÇokuĞraŞ H. Screening for Latent Tuberculosis in Children With Immune-mediated Inflammatory Diseases Treated With Anti-tumor Necrosis Factor Therapy: Comparison of Tuberculin Skin and T-SPOT Tuberculosis Tests. Arch Rheumatol. 2019 Jun 25;35(1):20-28. doi: 10.5606/ArchRheumatol.2020.7294. PMID: 32637916; PMCID: PMC7322294.
  • 15. Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children. Clin Infect Dis 2017;64:e1-e33.
  • 16. Solovic I, Sester M, Gomez-Reino JJ, Rieder HL, Ehlers S, Milburn HJ, et al. The risk of tuberculosis related to tumour necrosis factor antagonist therapies: a TBNET consensus statement. Eur Respir J 2010;36:1185-206.
  • 17. Keser G, Direskeneli H, Akkoç M, et al. II. RAED ConsensusMeeting Report. May 7,2005, Izmir.
  • 18. Cagatay T, Aydin M, Sunmez S, et al. Follow-up results of 702 patients receiving tumor necrosis factor-alpha antagonistsand evaluation of risk of tuberculosis. Rheumatol Int2010;30:1459-63.
  • 19. Hanta I, Ozbek S, Kuleci S, Kocabas A. The evaluation of latent tuberculosis in rheumatologic diseases for anti TNFTherapy: Experience with 192 patients. Clin Rheumatol 2008;27:1083-6.
  • 20. Kurt, O. K., Kurt, B., Talay, F., Tug, T., Soy, M., Bes, C. et al. Intermediate to long-term follow-up results of INH chemoprophylaxis prior to anti-TNF-alpha therapy in a high-risk area for tuberculosis. Wien Klin Wochenschr. 2013;125(19-20):616-620.
  • 21. Kaptan, Y., Suner, A., Taş, M. N., Oksel, F., Aksu, K., Sayiner, A. Tuberculosis despite latent infection screening and treatment in patients receiving TNF inhibitor therapy. Clin Rheumatol. 2021;40(9):3783-3788.
  • 22. Noguera-Julian A, Calzada-Hernández J, Brinkmann F, et al. Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study. Clin Infect Dis. 2020 Dec 17;71(10):2561-2569. doi: 10.1093/cid/ciz1138. PMID: 31796965.
  • 23. Dixon, W. G., Hyrich, K. L., Watson, K. D. et al. Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (BSRBR). Ann Rheum Dis. 2010;69(3):522-528.
  • 24. Miller EA, Ernst JD. Anti-TNF immunotherapy and tuberculosis reactivation: another mechanismrevealed. J Clin Invest 2009; 119: 1079-1082.
  • 25. Bruns H, Meinken C, SchauenbergP, et al. Anti-TNF immunotherapy reduces CD8+ Tcell mediated antimicrobial activity against Mycobacterium Tuberculosis in humans. J Clin Invest 2009; 119: 11167-1177.
  • 26. Jolanta Paluch-Oleś, Agnieszka Magryś. Identification of latent tuberculosis infection in rheumatic patients under consideration for treatment with anti-TNF-α agents. Arch Med Sci 2013; 9, 1: 112-117
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Çocuk Sağlığı ve Hastalıkları
Bölüm Araştırma Makalesi
Yazarlar

Yalçın Kara 0000-0003-0569-1106

Mahmut Can Kızıl 0000-0002-6231-4238

Merve İşeri Nepesov 0000-0003-4584-1818

Aslı Kavaz Tufan 0000-0003-1311-9468

Nuran Cetın 0000-0001-5763-9815

Yusuf Aydemir 0000-0003-0603-9742

Zeren Barış 0000-0002-4976-9924

Hilal Kaya Erdoğan 0000-0001-7059-5474

Ömer Kılıç 0000-0003-0168-4080

Ener Çağrı Dinleyici 0000-0002-0339-0134

Yayımlanma Tarihi 5 Nisan 2023
Gönderilme Tarihi 15 Ekim 2022
Kabul Tarihi 19 Ocak 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 16 Sayı: 2

Kaynak Göster

AMA Kara Y, Kızıl MC, İşeri Nepesov M, Kavaz Tufan A, Cetın N, Aydemir Y, Barış Z, Kaya Erdoğan H, Kılıç Ö, Dinleyici EÇ. Evaluation of tuberculosis frequency in children using biological agents. Pam Tıp Derg. Nisan 2023;16(2):238-246. doi:10.31362/patd.1189676
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