Alkadi Amjad, Alduaiji Najla, Alrehaily Ali
Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
Int J Health Sci (Qassim). 2017 Apr-Jun;11(2):41-44.
Tuberculosis (TB) is one of the world's deadliest diseases, and one-third of the world's population is infected with it. The link between antitumor necrosis factor therapy and reactivation of latent TB is well recognized. However, only limited studies have evaluated the risk of TB with rituximab, a B-cell-targeting therapeutic agent used recently for rheumatological diseases, primarily rheumatoid arthritis. Moreover, no studies have assessed this risk in TB endemic regions with a high incidence and prevalence of TB (e.g., Saudi Arabia).
To examine the risk of acquiring TB or activating latent TB in adult patients with rheumatological disease who received rituximab therapy.
Retrospective cohort study included 60 patients at King Faisal Specialist Hospital and Research Centre, Saudi Arabia, between October 1, 2010, and March 31, 2011.
Six patients (10%) were subsequently excluded because of the treatment for latent TB (5 patients) or prior treatment for TB (1 patient). The follow-up period was 6 months for 53 patients (98.15%) and 3 months for 1 patient (1.85%). During follow-up, none of the patients received the purified protein derivative skin test while radiological studies were performed for 30 patients (55.55%). 53 patients (98.15%) had no symptoms suggestive of TB upon follow-up, and no patient experienced a TB flare-up.
Rituximab can be considered a first line of therapy for the management of rheumatological diseases in the presence of the risk of TB reactivation, especially in endemic areas with a high prevalence and incidence of TB.
结核病是世界上最致命的疾病之一，全球三分之一的人口受到感染。抗肿瘤坏死因子治疗与潜伏性结核再激活之间的关联已得到充分认识。然而，仅有有限的研究评估了利妥昔单抗（一种最近用于治疗风湿性疾病，主要是类风湿性关节炎的B细胞靶向治疗药物）导致结核病的风险。此外，尚无研究在结核病高发和流行地区（如沙特阿拉伯）评估这种风险。
研究接受利妥昔单抗治疗的成年风湿性疾病患者感染结核病或激活潜伏性结核的风险。
回顾性队列研究纳入了沙特阿拉伯费萨尔国王专科医院和研究中心在2010年10月1日至2011年3月31日期间的60例患者。
6例患者（10%）随后因潜伏性结核治疗（5例）或既往结核治疗史（1例）被排除。53例患者（98.15%）的随访期为6个月，1例患者（1.85%）为3个月。随访期间，没有患者接受纯蛋白衍生物皮肤试验，30例患者（55.55%）进行了影像学检查。53例患者（98.15%）在随访时没有提示结核病的症状，也没有患者出现结核病复发。
在存在结核再激活风险的情况下，尤其是在结核病高流行和高发的地区，利妥昔单抗可被视为治疗风湿性疾病的一线药物。
