Frequency and tolerance of antituberculosis treatment according to national guidelines for prevention of risk of tuberculosis due to tumor necrosis factor blocker treatment.
OBJECTIVE
Tumor necrosis factor (TNF) blockers increase the risk of tuberculosis infection. National recommendations in France for prevention of latent tuberculosis recommend treatment by rifampicin (RIF) 600 mg/day and isoniazid (INH) 300 mg/day for 3 months. However, its toxicity is unknown in this context and is a subject of debate.


OBJECTIVE
To assess (a) frequency of prescription, (b) reasons for prescription, (c) tolerance of INH/RIF for prevention of tuberculosis.


METHODS
Systematic retrospective study of medical records of one tertiary rheumatology unit, from 2002 to 2007, of all patients who were prescribed INH/RIF before receiving TNF blockers.


METHODS
patients'demographic characteristics, reasons of prescription, tolerance and levels of aminotransferase before and during INH/RIF treatment.


METHODS
Descriptive and determination of risk factors of hepatotoxicity by multivariate logistic regression.


RESULTS
Of 1028 patients treated by TNF blockers between 2002 and 2007, 216 (21.1%) received INH/RIF treatment. Of 93 patients with complete data, 17 (18.2%) presented hepatotoxicity of which only one above 10 times the upper limit of the norm. Fourteen (15.0%) had other side effects. Ten (10.7%) patients had to interrupt INH/RIF for intolerance. Factors predicting intolerance were male sex, aminotransferases before treatment, a higher body mass index and leflunomide comedication.


CONCLUSIONS
This systematic case review indicates a high rate of necessity for preventive treatment by INH/RIF, and in particular for positive skin tests. This association had a high rate of hepatotoxicity without severe consequences. A better screening of patients before preventive therapy is needed.
Bray
Marie-Gaëlle
MG
Paris Descartes University, Medicine Faculty, UPRES-EA 4058, 75651 Paris, France. marie-gaelle.bray@psl.aphp.fr
Poulain
Cécile
C
Dougados
Maxime
M
Gossec
Laure
L
D000328:Adult; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007538:Isoniazid / Q000008:administration & dosage / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D012293:Rifampin / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D012720:Severity of Illness Index; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000995:Antitubercular Agents; D014409:Tumor Necrosis Factor-alpha; D007538:Isoniazid; D012293:Rifampin