Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
J Korean Med Sci. 2021 Mar 15;36(10):e70. doi: 10.3346/jkms.2021.36.e70.
Patients with rheumatoid arthritis (RA) undergoing targeted therapy have a higher risk of developing tuberculosis (TB). This requires diagnosis and treatment of latent tuberculosis infection (LTBI). We aimed to evaluate whether diagnosis and treatment of LTBI in RA are effective in Korea, and to estimate the risk of TB development by calculating the incidence rate of active TB among RA patients receiving targeted therapy.
We analyzed data from two prospective cohort studies of RA patients who received biologic disease-modifying antirheumatic drugs (bDMARDs) or Janus kinase (JAK) inhibitor. We selected new starters of targeted therapy and classified them into three groups receiving tumor necrosis factor (TNF) inhibitor, non-TNF inhibitor, and JAK inhibitor, respectively. We then compared LTBI prevalence, treatments, and active TB incidence during first-line therapy in each group.
A total of 765 RA patients (574 TNF inhibitor users, 132 non-TNF inhibitor users, and 59 JAK inhibitor users) were included in this study. Observation periods were 1,255.2 person-years (PYs), 264.7 PYs, and 53.3 PYs, respectively. All 765 patients underwent LTBI screening, and the positivity rate was 26.5% (n = 203). Of the 203 LTBI-positive patients, 189 (93.1%) received treatment. Only one patient, who was in the TNF inhibitor group, and was negative for the interferon gamma release assay (IGRA), did not receive LTBI treatment and developed active TB during follow-up.
Although the prevalence of LTBI in RA patients who started targeted therapy was slightly elevated, the Korean guidelines specifying LTBI screening and treatment were effective in preventing latent TB from becoming active.
接受靶向治疗的类风湿关节炎（RA）患者发生结核病（TB）的风险较高。这需要诊断和治疗潜伏性结核感染（LTBI）。我们旨在评估韩国 RA 患者接受靶向治疗时诊断和治疗 LTBI 的效果，并通过计算接受靶向治疗的 RA 患者中活动性 TB 的发生率来估计 TB 发展的风险。
我们分析了接受生物疾病修饰抗风湿药物（bDMARDs）或 Janus 激酶（JAK）抑制剂的 RA 患者的两项前瞻性队列研究的数据。我们选择了新开始靶向治疗的患者，并将他们分为分别接受肿瘤坏死因子（TNF）抑制剂、非 TNF 抑制剂和 JAK 抑制剂的三组。然后，我们比较了每组一线治疗期间 LTBI 的患病率、治疗和活动性 TB 的发生率。
共有 765 例 RA 患者（574 例 TNF 抑制剂使用者、132 例非 TNF 抑制剂使用者和 59 例 JAK 抑制剂使用者）纳入本研究。观察期分别为 1255.2 人年（PYs）、264.7 PYS 和 53.3 PYS。所有 765 例患者均接受 LTBI 筛查，阳性率为 26.5%（n=203）。203 例 LTBI 阳性患者中，189 例（93.1%）接受了治疗。只有一名患者在 TNF 抑制剂组中，干扰素γ释放试验（IGRA）阴性，未接受 LTBI 治疗，并在随访期间发生活动性 TB。
尽管开始靶向治疗的 RA 患者中 LTBI 的患病率略有升高，但韩国的 LTBI 筛查和治疗指南在预防潜伏性 TB 转为活动性方面是有效的。
