title: Is it safe to use anti-TNF-α agents for tuberculosis in children suffering with chronic rheumatic disease?
abstract: To determine the incidence of latent tuberculosis infection and evaluate the follow-up protocol of the patients diagnosed with juvenile idiopathic arthritis (JIA) and other chronic rheumatologic diseases treated with anti-TNF-α treatment (etanercept, infliximab, adalimumab) in Turkey, 144 patients were evaluated retrospectively for the development of tuberculosis. Patients were evaluated every 6 months for tuberculosis using history, physical examination, tuberculin skin test (TST), chest radiographs, and, when required, examination of sputum/early morning gastric aspirates for acid-fast bacilli and chest tomography. A tuberculin skin test over 10 mm induration was interpreted as positive. Patients were diagnosed with JIA (n = 132), enthesitis-related arthritis (ERA; n = 14), juvenile psoriatic arthritis (JPsA; n = 4), chronic idiopathic uveitis (n = 4), and chronic arthritis related to FMF (n = 8). Mean age was 12.25 ± 3.96 years (4.08-19.41 years), mean duration of illness was 5.86 ± 3.77 years (0.66-15 years), and the mean duration of anti-TNF-α treatment was 2.41 ± 1.47 years (0.6-7 years). Anti-TNF-α agents prescribed were etanercept (n = 133), infliximab (n = 30), and adalimumab (n = 6). When unresponsive to one anti-TNF-α therapy, patients were switched to another. There was no history of contact with individuals having tuberculosis. During follow-up, seven patients (4.8%) with positive TST were given INH prophylaxis. One oligoarticular JIA patient (0.69%) diagnosed with secondary uveitis who had been followed for 5 years and had been using infliximab for 2 years, developed a positive Quantiferon-TB test while on INH prophylaxis. He was started on an anti-tuberculosis drug regimen. In conclusion, anti-TNF-α treatment in children with chronic inflammatory disease is safe. Follow-up every 6 months of children on anti-TNF-α treatment with respect to tuberculosis by the pediatric infectious disease department is important to prevent possible complications.
authors.affiliation: Infectious Diseases, Clinical Immunology and Allergy Division, Department of Pediatrics, Cerrahpasa Medical School, Istanbul University, Cerrahpasa, Istanbul, Turkey. omerkilic7@yahoo.com
authors.forename: Omer
authors.initials: O
authors.lastname: Kilic
authors.forename: Ozgur
authors.initials: O
authors.lastname: Kasapcopur
authors.forename: Yildiz
authors.initials: Y
authors.lastname: Camcioglu
authors.forename: Haluk
authors.initials: H
authors.lastname: Cokugras
authors.forename: Nil
authors.initials: N
authors.lastname: Arisoy
authors.forename: Necla
authors.initials: N
authors.lastname: Akcakaya
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use*; D001168:Arthritis / Q000188:drug therapy / Q000453:epidemiology; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000453:epidemiology; D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D000069285:Infliximab; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D013902:Radiography, Thoracic; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D016896:Treatment Outcome; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept