title: Increased risk of tuberculosis in patients treated with antitumor necrosis factor alpha.
abstract: Drugs which antagonize tumor necrosis factor alpha (TNF-alpha) are known to increase the risk of tuberculosis. We aimed to evaluate the risk of tuberculosis in patients treated with anti-TNF-alpha, in Turkey. Two hundred and forty patients receiving anti-TNF-alpha, from December 2005 to December 2007, were included in the study. All participants provided a history and underwent a physical examination, a chest X-ray, and a tuberculin skin test. Isoniazid treatment was initiated in those patients with a latent infection, and they were followed up at 2-month intervals. A Bacillus Calmette-Guerin (BCG) scar was present in 184 patients (77.6%). The mean tuberculin skin test induration of patients on admission was 10.7+/-7.0 mm. Male gender and the presence of a BCG scar were predictors of a higher tuberculin skin test result (P<0.05), while there was no significant effect of age on the tuberculin skin test (P>0.05). Of the 240 subjects, 229 (95.4%) received methotrexate or corticosteroid treatment prior to anti-TNF-alpha therapy. Isoniazid treatment preceded anti-TNF-alpha administration in 185 (77.1%) of the 240 patients. Two patients developed tuberculosis (incidence 833/100,000). There was no correlation between initial and 12-month tuberculin skin test results (P>0.05). Tuberculin skin test conversion was detected in five subjects during the 12-month follow-up; however, none developed active tuberculosis. One patient developed a drug reaction secondary to etanercept, and another demonstrated hepatotoxicity due to isoniazid. This study shows that anti-TNF-alpha therapy increases the risk of tuberculosis, despite treatment of latent infection.
authors.affiliation: Department of Pulmonary Diseases, Faculty of Medicine, University of Gaziantep, Gaziantep 27035, Turkey. osmanelbek@yahoo.com
authors.forename: Osman
authors.initials: O
authors.lastname: Elbek
authors.forename: Meral
authors.initials: M
authors.lastname: Uyar
authors.forename: Neriman
authors.initials: N
authors.lastname: Aydin
authors.forename: Sermin
authors.initials: S
authors.lastname: Börekçi
authors.forename: Nazan
authors.initials: N
authors.lastname: Bayram
authors.forename: Hasan
authors.initials: H
authors.lastname: Bayram
authors.forename: Oner
authors.initials: O
authors.lastname: Dikensoy
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000494:pharmacology; D000328:Adult; D000368:Aged; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000494:pharmacology; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D008727:Methotrexate / Q000494:pharmacology; D008875:Middle Aged; D009163:Mycobacterium bovis; D018124:Receptors, Tumor Necrosis Factor; D012306:Risk; D016896:Treatment Outcome; D014374:Tuberculin Test / Q000009:adverse effects*; D014376:Tuberculosis / Q000175:diagnosis / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000097:blood* / Q000378:metabolism*
chemical_list: D000305:Adrenal Cortex Hormones; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000068800:Etanercept; D007538:Isoniazid; D008727:Methotrexate