治疗潜伏性结核后使用肿瘤坏死因子抑制剂的结核发病风险。

Active tuberculosis risk with tumor necrosis factor inhibitors after treating latent tuberculosis.

机构信息

From the *Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; †Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI; and ‡Division of Infectious Disease, Department of Internal Medicine, and §Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.

出版信息

J Clin Rheumatol. 2014 Mar;20(2):68-73. doi: 10.1097/RHU.0000000000000074.

DOI:10.1097/RHU.0000000000000074

PMID:24561408

Abstract

BACKGROUND

Active tuberculosis (TB) risk increases during anti-tumor necrosis factor (TNF) therapy; therefore, latent TB infection (LTBI) screening is recommended in potential TNF inhibitor users. It is unclear whether anti-TNF therapy increases the risk of active TB infection even after standard LTBI treatment.

OBJECTIVE

The objective of this study was to compare the risk of active TB development in LTBI-positive versus LBTI-negative TNF inhibitor users following the current national LTBI treatment guidelines for LTBI.

METHODS

We retrospectively studied 949 TNF inhibitor users with immune-mediated inflammatory diseases from 2005 to 2012 at the Yonsei University Health System. We compared the incidence of active TB among LTBI-positive TNF inhibitor users treated according to national guidelines (n = 256) and LTBI-negative TNF inhibitor users (n = 521), using Poisson regression.

RESULTS

The active TB incidence was 1107 per 100,000 patient-years in LTBI-positive TNF inhibitor users who received standard LTBI treatment and 490 per 100,000 patient-years in LTBI-negative TNF inhibitor users. Analysis showed that despite this numerical trend active TB risk was not statistically significantly elevated in LTBI-positive versus LTBI-negative TNF inhibitor users (incidence risk ratio, 2.15; P = 0.24; 95% confidence interval, 0.6-7.7).

CONCLUSIONS

This study demonstrated no statistically significantly increased risk of active TB in LTBI-positive TNF inhibitor users who received standard LTBI treatment compared with LTBI-negative TNF inhibitor users.

摘要

背景

在使用抗肿瘤坏死因子（TNF）治疗期间，活动性结核病（TB）的风险增加；因此，建议在潜在的 TNF 抑制剂使用者中筛查潜伏性 TB 感染（LTBI）。目前尚不清楚在标准 LTBI 治疗后，抗 TNF 治疗是否会增加活动性 TB 感染的风险。

目的

本研究旨在比较 LTBI 阳性与 LTBI 阴性 TNF 抑制剂使用者在遵循当前国家 LTBI 治疗指南治疗 LTBI 后，发生活动性 TB 的风险。

方法

我们回顾性研究了 2005 年至 2012 年在延世大学健康系统就诊的 949 例患有免疫介导的炎症性疾病的 TNF 抑制剂使用者。我们使用泊松回归比较了根据国家指南（n=256）治疗的 LTBI 阳性 TNF 抑制剂使用者和 LTBI 阴性 TNF 抑制剂使用者（n=521）中活动性 TB 的发生率。

结果

在接受标准 LTBI 治疗的 LTBI 阳性 TNF 抑制剂使用者中，活动性 TB 的发生率为每 100,000 患者-年 1107 例，而在 LTBI 阴性 TNF 抑制剂使用者中为每 100,000 患者-年 490 例。分析表明，尽管存在这种数值趋势，但 LTBI 阳性与 LTBI 阴性 TNF 抑制剂使用者之间的活动性 TB 风险无统计学显著升高（发病率风险比，2.15；P=0.24；95%置信区间，0.6-7.7）。