Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia; Research office, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
J Infect Public Health. 2024 Jun;17(6):1134-1141. doi: 10.1016/j.jiph.2024.04.016. Epub 2024 Apr 21.
The risk of infection including tuberculosis (TB) infection or reactivation during biological therapy with the current various clinical application is a major concern. This risk may be higher in countries endemic to TB. Our aim of this study is to determine the risk of TB infection in patients receiving 3 biological treatments, Adalimumab, Etanercept and Tocilizumab.
A retrospective cohort study extending over 2 years follow-up for all patients receiving Adalimumab, Etanercept and Tocilizumab for various clinical indications in a tertiary care center in Saudi Arabia.
Over the period of 2015-2019, A total of 410 patients received Adalimumab, 271 received Etanercept and 58 patients received Tocilizumab. Rheumatoid arthritis was the most common indication for therapy in all groups and for Adalimumab the most common indication was inflammatory bowel disease, for Etanercept was psoriatic arthritis and for Tocilizumab was juvenile idiopathic arthritis. After a mean follow up period of 36 ± 8.9 months for patients receiving Adalimumab, 21.5 ± 8.4 months for patients receiving Etanercept and 21 ± 2.5 months for patients receiving Tocilizumab there were no reported cases of TB infection in all groups. Only one patient was diagnosed with latent TB 7 months later after starting Adalimumab and tow patients after starting Etanercept. The overall Interferon Gamma Release Assays (IGRA) positivity rate was 9.7%. There was significant association between IGRA positivity rate and patient age. The cutoff age in which IGRA positivity has significantly increased was 53.20 years.
In our study, patients receiving Etanercept, Adalimumab and Tocilizumab had no increased risk of TB infection. Only 0.3% of patients treated with Adalimumab and 0.9% of patients treated with Etanercept converted to a positive IGRA during therapy.
在当前各种临床应用中，使用生物治疗时感染（包括结核感染或再激活）的风险是一个主要关注点。在结核病流行的国家，这种风险可能更高。本研究旨在确定在沙特阿拉伯一家三级护理中心接受阿达木单抗、依那西普和托珠单抗三种生物治疗的患者感染结核的风险。
这是一项回顾性队列研究，对 2015 年至 2019 年期间在沙特阿拉伯一家三级护理中心因各种临床适应证接受阿达木单抗、依那西普和托珠单抗治疗的所有患者进行了为期 2 年的随访。
在 2015 年至 2019 年期间，共有 410 例患者接受阿达木单抗治疗，271 例患者接受依那西普治疗，58 例患者接受托珠单抗治疗。在所有组中，治疗的最常见适应证是类风湿关节炎，阿达木单抗最常见的适应证是炎症性肠病，依那西普最常见的适应证是银屑病关节炎，托珠单抗最常见的适应证是青少年特发性关节炎。在接受阿达木单抗治疗的患者中位随访 36 ± 8.9 个月、接受依那西普治疗的患者中位随访 21.5 ± 8.4 个月、接受托珠单抗治疗的患者中位随访 21 ± 2.5 个月后，所有组均未报告结核感染病例。只有 1 例患者在开始使用阿达木单抗后 7 个月被诊断为潜伏性结核，2 例患者在开始使用依那西普后被诊断为潜伏性结核。总的干扰素释放试验（IGRA）阳性率为 9.7%。IGRA 阳性率与患者年龄之间存在显著相关性。IGRA 阳性率显著增加的临界年龄为 53.20 岁。
在本研究中，接受依那西普、阿达木单抗和托珠单抗治疗的患者结核感染风险没有增加。只有 0.3%接受阿达木单抗治疗的患者和 0.9%接受依那西普治疗的患者在治疗过程中 IGRA 转为阳性。
