Hanyang University Hospital for Rheumatic Diseases, 17 Haengdang-dong, Seongdong-Gu, Seoul 133-792, Republic of Korea.
J Rheumatol. 2011 Oct;38(10):2218-23. doi: 10.3899/jrheum.110373. Epub 2011 Aug 15.
To assess the incidence and relative risk of new tuberculosis (TB) infections in Korean patients with ankylosing spondylitis (AS) and patients with AS who are undergoing treatment with tumor necrosis factor (TNF) blockers.
New cases of TB were identified by reviewing the medical records of 919 patients with AS not treated with TNF blockers and those of 354 patients with AS treated with adalimumab (n = 66), infliximab (n = 78), or etanercept (n = 210) between 2002 and 2009. Reference data were obtained from the Korean National Tuberculosis Association.
The mean incidence rate of TB was 69.8 per 100,000 person-years (PY) in the general population, 308 per 100,000 PY in the TNF blocker-naive AS cohort, and 561 per 100,000 PY in the TNF blocker-exposed AS cohort. The incidence rate of TB in the infliximab-treated AS cohort (540 per 100,000 PY) was higher than that in the adalimumab-treated AS cohort (490 per 100,000 PY). No cases of TB occurred in the etanercept-treated AS cohort. Comparing the relative risks of TB infections between the TNF blocker-exposed AS cohort and the TNF blocker-naive AS cohort, no statistically significant difference was identified (risk ratio 0.53; 95% CI 0.144-1.913).
The risk of TB was higher in the TNF blocker-naive AS cohort than it was in the general population. However, the risk of TB was not increased in the TNF blocker-exposed AS cohort compared with the TNF blocker-naive AS cohort. Among patients with AS, etanercept is associated with a lower risk of TB compared with monoclonal antibodies.
评估未接受肿瘤坏死因子（TNF）阻滞剂治疗的强直性脊柱炎（AS）患者和接受阿达木单抗（n = 66）、英夫利昔单抗（n = 78）或依那西普（n = 210）治疗的 AS 患者中新发结核（TB）感染的发生率和相对风险。
通过回顾 2002 年至 2009 年期间未接受 TNF 阻滞剂治疗的 919 例 AS 患者和接受阿达木单抗、英夫利昔单抗或依那西普治疗的 354 例 AS 患者的病历，确定新发生的 TB 病例。参考数据来自韩国国家结核病协会。
一般人群中 TB 的平均发病率为 69.8/100,000 人年（PY），TNF 阻滞剂初治 AS 队列为 308/100,000 PY，TNF 阻滞剂暴露 AS 队列为 561/100,000 PY。英夫利昔单抗治疗的 AS 队列（540/100,000 PY）的 TB 发病率高于阿达木单抗治疗的 AS 队列（490/100,000 PY）。依那西普治疗的 AS 队列未发生 TB 病例。比较 TNF 阻滞剂暴露的 AS 队列和 TNF 阻滞剂初治的 AS 队列的 TB 感染相对风险，差异无统计学意义（风险比 0.53；95%CI 0.144-1.913）。
TNF 阻滞剂初治的 AS 队列的 TB 风险高于一般人群。然而，与 TNF 阻滞剂初治的 AS 队列相比，TNF 阻滞剂暴露的 AS 队列的 TB 风险并未增加。在 AS 患者中，与单克隆抗体相比，依那西普与较低的 TB 风险相关。
