Comprehensive tuberculosis screening program in patients with inflammatory arthritides treated with golimumab, a human anti-tumor necrosis factor antibody, in Phase III clinical trials.
OBJECTIVE
Reactivation of Mycobacterium tuberculosis infection is a major complication in patients treated with anti-tumor necrosis factor (anti-TNF) agents. We report on the 5 cases of active tuberculosis (TB) that developed in the Golimumab Phase III Program (3 with rheumatoid arthritis, 1 with psoriatic arthritis, and 1 with ankylosing spondylitis) through 1 year among 2,210 patients receiving golimumab.


METHODS
Data from global studies were used for an in-depth evaluation of the 5 cases of TB through week 52. Integrated safety data were evaluated for potential hepatotoxicity in patients treated with anti-TB therapy.


RESULTS
No active TB developed among 317 patients receiving golimumab and treated for latent TB with isoniazid. Active TB occurred in 5 patients not treated with isoniazid by week 52 (in 2 patients by week 24); all of the patients had negative TB screening tests (per the local guidelines) and resided in countries with high background rates of TB. No deaths were due to TB. Across all of the groups (placebo and golimumab), alanine aminotransferase and aspartate aminotransferase elevations occurred in greater proportions of patients treated for latent TB infection versus not treated; elevations were largely mild (<3 times the upper limit of normal).


CONCLUSIONS
Comprehensive TB screening kept the number of active TB cases relatively low despite conducting the studies in TB-endemic regions. Treatment for latent TB infection appeared effective, since no patients treated for latent TB had TB reactivation. Concurrent treatment with golimumab and anti-TB medication was generally well tolerated. Clinicians should remain vigilant for development of active TB after initiation of TNF inhibitors, since prompt diagnosis and treatment can improve outcomes.
Janssen Research & Development, LLC, Spring House, and University of Pennsylvania School of Medicine, Philadelphia, USA. EHsia@its.jnj.com
Elizabeth C
EC
Hsia
John J
JJ
Cush
Eric L
EL
Matteson
Anna
A
Beutler
Mittie K
MK
Doyle
Benjamin
B
Hsu
Stephen
S
Xu
Mahboob U
MU
Rahman
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D001168:Arthritis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D055985:Latent Tuberculosis / Q000150:complications* / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
D000911:Antibodies, Monoclonal; D000995:Antitubercular Agents; D014409:Tumor Necrosis Factor-alpha; C529000:golimumab; D007538:Isoniazid