Active Tuberculosis in Patients Receiving Biological Therapy

Öz

Biological therapies are an important risk factor for opportunistic infections, especially tuberculosis infection and disease. In this study, we aimed to evaluate the incidence rate of active tuberculosis disease in patients receiving biologic agent therapy in Bursa Uludag University Hospital. Patients who received treatment with biologic agents for various diagnoses between January 2010 and January 2023 in our hospital's Department of Rheumatology were analyzed retrospectively. Symptoms and physical examination findings, tuberculin skin tests, and preventive treatment status of patients diagnosed with tuberculosis were evaluated. A total of 2524 patient files of patients diagnosed with rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Behçet's disease, eosinophilic granulomatous polyangiitis or Still's disease and receiving biological agent treatment were retrospectively analyzed. A total of 13 (0.51%) patients developed active tuberculosis disease. The incidence rate was calculated as 515/100.000. Of these, 69% had pulmonary and 31% extrapulmonary involvement. The median duration of active tuberculosis disease in these patients was 28 months. TNF-alpha blockers were used by 69% of the patients, IL-6 inhibitors by 15%, JAK inhibitors by 0.07% and CD20 monoclonal antibody inhibitors by 0.07%. The incidence rate of tuberculosis is still high in patients receiving treatment with biological agents in our hospital. In the follow-up of these patients, detailed evaluation for latent tuberculosis before treatment and close follow-up and screening for the development of active tuberculosis during the treatment process are necessary.

Anahtar Kelimeler

• Biological Therapy
• Tuberculosis
• latent tuberculosis

Biyolojik Tedavi Alan Hastalarımızda Aktif Tüberküloz

Öz

Biyolojik tedaviler, özellikle latent tüberküloz enfeksiyonu gibi fırsatçı enfeksiyonlar için önemli bir risk faktörüdür. Bu araştırmada, Bursa Uludağ Üniversitesi Sağlık Uygulama ve Araştırma Merkezinde biyolojik ajan tedavisi alan hastalarda aktif tüberküloz hastalığı gelişme sıklığı ve aktif tüberküloz saptanan olguların klinik özelliklerinin değerlendirilmesi amaçlandı. Hastanemizde Romatoloji Bilim dalında Ocak 2010 ve Ocak 2023 tarihleri arasında, farklı tanılarla biyolojik ajanlar ile tedavi alan hastalar geriye dönük olarak incelendi. Tüberküloz tanısı alan hastaların semptom ve fizik muayene bulguları, tüberkülin cilt testleri, koruyucu tedavi alma durumları değerlendirildi. Romatoid artrit, juvenil romatoid artrit, ankilozan spondilit, psöriatik artrit, Behçet hastalığı, eozinofilik granülomatöz polianjitis veya Still hastalığı tanısı bulunan ve biyolojik ajan tedavisi alan toplam 2524 hasta dosyası geriye dönük incelendi. Toplam 13 (% 0,51) hastada aktif tüberküloz hastalığı geliştiği gözlendi. İnsidans hızı 515/100.000 olarak hesaplandı. Bunların %69’u pulmoner, %31’i ekstrapulmoner tutulum olduğu gözlendi. Bu hastalarda, aktif tüberküloz hastalığı gelişme süresi 28 ay olarak saptandı. Hastaların %69’u TNF-alfa blokörü, %15’i IL-6 inhibitörü, %0,07’si JAK inhibitörü ve %0,07’si CD20 monoklonal antikor inhibitörü kullanmıştı. Hastanemizde biyolojik ajanlarla tedavi alan hastalarda tüberküloz insidans hızı halen yüksektir. Bu hastaların izlemlerinde tedavi öncesi latent tüberküloz yönünden detaylı değerlendirme ve tedavi süreçlerinde aktif tüberküloz gelişimi yönünden yakın takip ve tarama gereklidir.

Anahtar Kelimeler

• tüberküloz
• latent tüberküloz
• tüberküloz hastalığı
• biyolojik tedaviler

Kaynakça

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