Division of Rheumatology, Department of Medicine, Loma Linda University Medical Center, 11234 Anderson St, Suite 1503A, Loma Linda, California, 92354, USA.
Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, 11234 Anderson St, Suite 1503A, Loma Linda, California, 92354, USA.
Clin Rheumatol. 2020 Aug;39(8):2291-2297. doi: 10.1007/s10067-020-04991-y. Epub 2020 Feb 28.
There are no studies assessing the development of latent tuberculosis infection (LTBI) in patients on tumor necrosis factor inhibitors (TNFα-I) in high TB prevalence areas of the USA. Our objective was to assess the rate of LTBI development in rheumatoid arthritis (RA) patients on TNFα-I therapies in San Bernardino and Riverside Counties of California, high TB prevalence areas in the US.
Data were extracted from the electronic health record for 217 adult RA patients across three health centers from January 2010 to January 2017 who have had at least 1 year of TNFα-I use and negative initial QuantiFERON Gold status. Demographics, TNFα-I type, duration of use, TB risk factors, QuantiFERON results, rates of re-screening, TB test seroconversion, and its association with drug use and other factors were assessed.
Of the 217 patients, 115 (53%) received baseline and annual screening for LTBI. LTBI was diagnosed in 9.4% (10) of patients. Four patients were on infliximab, three on golimumab, two on adalimumab, and one on etanercept. Hispanic patients tended to have a greater than 200% increase in odds of seroconversion compared to non-Hispanic patients. Infliximab and golimumab were associated with a 92% and 400% increase in odds of seroconversion, respectively.
The LTBI developed in 9.4% of the patients. This is higher than what is reported for previous US studies. Screening for LTBI in the US should take into consideration TB prevalence, ethnicity, drug type, and duration of use. For our local population and similar populations, annual screening should be practiced. Key Points • Although patients on TNFα inhibitor (TNFα-I) therapy are at high risk of latent tuberculosis infection (LTBI), few studies report the rate of LTBI in patients living in high prevalence areas of the US. • The rate of LTBI was 9.4% in patients on TNFα-I therapy in Southern California. The risk of seroconversion was higher in patients of Hispanic ethnicity and also higher for those on infliximab and golimumab compared to those on other TNFα-I therapies. • Screening guidelines for LTBI screening on TNFα-I should consider local TB prevalence, drugs used, duration of use and ethnicity for cost efficient, and optimal healthcare.
在美国结核病高发地区，目前尚无评估肿瘤坏死因子抑制剂（TNFα-I）治疗患者中潜伏性结核感染（LTBI）发展情况的研究。我们的目的是评估加利福尼亚州圣贝纳迪诺县和河滨县 TNFα-I 治疗的类风湿关节炎（RA）患者中 LTBI 的发展率，这两个地区是美国结核病高发地区。
我们从 2010 年 1 月至 2017 年 1 月期间的三个医疗中心的 217 名成年 RA 患者的电子健康记录中提取数据，这些患者至少使用了 1 年的 TNFα-I，并且初始 QuantiFERON Gold 检测结果为阴性。评估了人口统计学、TNFα-I 类型、使用时间、结核病风险因素、QuantiFERON 检测结果、重新筛查率、TB 检测血清转化率及其与药物使用和其他因素的相关性。
在 217 名患者中，有 115 名（53%）接受了 LTBI 的基线和年度筛查。有 9.4%（10 名）的患者被诊断为 LTBI。4 名患者接受英夫利昔单抗治疗，3 名患者接受戈利木单抗治疗，2 名患者接受阿达木单抗治疗，1 名患者接受依那西普治疗。与非西班牙裔患者相比，西班牙裔患者的血清转化率增加了 200%以上。英夫利昔单抗和戈利木单抗分别使血清转化率增加了 92%和 400%。
9.4%的患者发生了 LTBI。这高于以前美国研究的报告。美国的 LTBI 筛查应考虑结核病流行率、种族、药物类型和使用时间。对于我们当地的人群和类似人群，应每年进行筛查。
关键点
· 尽管接受肿瘤坏死因子抑制剂（TNFα-I）治疗的患者存在潜伏性结核感染（LTBI）的高风险，但很少有研究报告美国高流行地区患者的 LTBI 发生率。
· 在南加州接受 TNFα-I 治疗的患者中，LTBI 的发生率为 9.4%。与其他 TNFα-I 治疗相比，西班牙裔患者的血清转化率更高，而且接受英夫利昔单抗和戈利木单抗治疗的患者的血清转化率也更高。
· TNFα-I 治疗 LTBI 筛查的筛查指南应考虑当地结核病流行率、所用药物、使用时间和种族，以实现成本效益和最佳医疗保健。
