Department of Rheumatology, Faculty of Medicine, Marmara University, İstanbul, Turkey
Department of Pulmonary and Critical Care Medicine, Faculty of Medicine, Marmara University, İstanbul, Turkey
Turk J Med Sci. 2021 Aug 30;51(4):1689-1694. doi: 10.3906/sag-2010-311.
BACKGROUND/AIM: Tumor necrosis factor-alfa (TNF-a) antagonists are extensively utilized in the treatment of inflammatory rheumatic diseases and also shown to be effective in Behçet’s disease (BD) patients with major organ involvement. In this study, we aimed to re- evaluate the incidence of tuberculosis (TB) infection after anti-TNFa treatments and to reveal the risk of TB in BD.
Data of patients who received anti-TNFa treatment between 2005 and 2018 were assessed retrospectively. Demographic features, TNF-a antagonist type/treatment time, tuberculosis skin test (TST) and QuantiFERON results, isoniazid prophylaxis status, and concomitant corticosteroid (CS) treatments were collected.
A total of 1277 (male/female = 597/680; median age = 49 years) patients were treated with TNF-a antagonist for a median of 33 months (Q1:12, Q3:62). Thirteen (1%) patients developed TB during the follow-up period. Within 13 TB-positive patients, 7 of them had pulmonary, and 7 had extrapulmonary TB. Although, the median time of (month) TNF-a antagonist treatment was higher in TB-positive patients than negative ones, the difference was not statistically significant (48 and 33 months, respectively, p = 0.47). Similarly, TB-positive patients were treated with CSs more than TB-negative patients (80% vs. 60%). Time from the initiation of TNF-a antagonist treatment to the diagnosis of TB had a median of 40 months (Q1-Q3: 22-56). There was a statistically significant increase of TB development in BD patients than non-BD patients after TNF-a antagonists (7.5% vs. 0.8%, respectively, p = 0.007). When we combined our patients with the other series from Turkey, among 12928 patients who received TNF-a antagonists, TB was positive in 12 (3.9%) of 305 BD patients compared to 112 (0.9%) of 12623 non-BD patients (p < 0.00001).
Our results suggest a higher frequency of TB infections in BD patients with TNF-a antagonists. As biologic agents are increasingly used for major organ involvement in current practice for BD, screening mechanisms should be carefully implemented.
背景/目的：肿瘤坏死因子-α（TNF-α）拮抗剂广泛用于治疗炎症性风湿病，并且在有重要器官受累的贝赫切特病（BD）患者中也显示出有效性。在这项研究中，我们旨在重新评估抗 TNF-α治疗后结核（TB）感染的发生率，并揭示 BD 中 TB 的风险。
回顾性评估了 2005 年至 2018 年间接受抗 TNF-α治疗的患者的数据。收集了人口统计学特征、TNF-α拮抗剂类型/治疗时间、结核菌素皮肤试验（TST）和 QuantiFERON 结果、异烟肼预防状况以及同时使用皮质类固醇（CS）治疗的情况。
共 1277 名（男/女=597/680；中位年龄=49 岁）患者接受 TNF-α拮抗剂治疗，中位时间为 33 个月（Q1：12，Q3：62）。在随访期间，有 13 名（1%）患者发生 TB。在 13 名 TB 阳性患者中，有 7 名患有肺部 TB，7 名患有肺外 TB。尽管 TB 阳性患者的 TNF-α拮抗剂治疗时间中位数高于阴性患者，但差异无统计学意义（分别为 48 和 33 个月，p=0.47）。同样，TB 阳性患者接受 CS 的治疗多于 TB 阴性患者（80% vs. 60%）。从开始 TNF-α拮抗剂治疗到诊断 TB 的时间中位数为 40 个月（Q1-Q3：22-56）。BD 患者在接受 TNF-α拮抗剂治疗后发生 TB 的比例明显高于非 BD 患者（分别为 7.5%和 0.8%，p=0.007）。当我们将我们的患者与土耳其的其他系列研究合并时，在接受 TNF-α拮抗剂治疗的 12928 名患者中，TB 阳性的 305 名 BD 患者中有 12 名（3.9%），而 12623 名非 BD 患者中有 112 名（0.9%）（p<0.00001）。
我们的结果表明，BD 患者使用 TNF-α拮抗剂后，TB 感染的频率更高。由于生物制剂在当前 BD 中对主要器官受累的治疗中越来越多地使用，应谨慎实施筛查机制。
