title: High incidence of tuberculosis infection in rheumatic diseases and impact for chemoprophylactic prevention of tuberculosis activation during biologics therapy.
abstract: We conducted a long-term follow-up study in patients with rheumatic diseases who were candidates for biologics treatment to evaluate the effects of biologic agents on the risk of tuberculosis infection and the effect of prophylactic treatment on tuberculosis activation. One hundred one patients with rheumatic diseases who were candidates for biologics treatment were recruited, and 57 healthy subjects were recruited as controls. Tuberculin skin test (TST) and the T-SPOT.TB test were performed for all subjects at baseline. Follow-up testing by the T-SPOT.TB assay was performed every 6 months in patients with rheumatic diseases and at 2 years of recruitment in the healthy controls. In patients with rheumatic diseases and healthy controls, the TST-positive (induration, ≥10 mm) rates were 37.6% (38/101) and 34.0% (18/53), respectively (P > 0.05), while the T-SPOT.TB-positive rates were 46.5% (47/101) and 21.1 (12/57), respectively (P = 0.0019). Fifty-two patients were followed up at month 6 with a T-SPOT.TB-positive rate of 40.4%, and 49 were followed up for ≥12 months with a T-SPOT.TB-positive rate of 36.7%, with no significant difference in the positive rate at different time points including baseline (P > 0.05). Long-term follow-up revealed that conversion to T-SPOT.TB positivity occurred only in the biologics treatment group, with a positive conversion rate of 11.2% (4/38). Most importantly, no latent tuberculosis developed into active tuberculosis during follow-up with T-SPOT.TB screening and preemptive treatment with isoniazid. Biologics treatment appears to increase the risk of tuberculosis infection. However, tuberculosis activation could be prevented by preemptive isoniazid treatment in patients with latent tuberculosis infection while receiving biologics therapy.
authors.affiliation: Department of Rheumatology, Shanghai Guang Hua Hospital of Integrated Traditional and Western Medicine, Shanghai, China. dongyihe@medmail.com.cn
authors.forename: Dongyi
authors.initials: D
authors.lastname: He
authors.forename: Fengmin
authors.initials: F
authors.lastname: Bai
authors.forename: Shu
authors.initials: S
authors.lastname: Zhang
authors.forename: Ting
authors.initials: T
authors.lastname: Jiang
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhu
authors.forename: Tao
authors.initials: T
authors.lastname: Yue
authors.forename: Lingyun
authors.initials: L
authors.lastname: Shao
authors.forename: Yan
authors.initials: Y
authors.lastname: Gao
authors.forename: Yun
authors.initials: Y
authors.lastname: Feng
authors.forename: Xinhua
authors.initials: X
authors.lastname: Weng
authors.forename: Hejian
authors.initials: H
authors.lastname: Zou
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Wenhong
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage*; D001688:Biological Products / Q000008:administration & dosage / Q000009:adverse effects*; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007538:Isoniazid / Q000008:administration & dosage; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000150:complications*; D014376:Tuberculosis / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D001688:Biological Products; D007166:Immunosuppressive Agents; D007538:Isoniazid
references.citation: Best Pract Res Clin Rheumatol. 2004 Feb;18(1):59-80
references.pmid: 15123038
references.citation: J Clin Rheumatol. 2007 Aug;13(4):219-20
references.pmid: 17762459
references.citation: Clin Infect Dis. 2004 Oct 15;39(8):1254-5
references.pmid: 15486857
references.citation: Clin Infect Dis. 2004 Aug 1;39(3):295-9
references.pmid: 15306993
references.citation: Clin Vaccine Immunol. 2011 Dec;18(12):2102-8
references.pmid: 21994356
references.citation: Ann Rheum Dis. 2005 Sep;64(9):1360-1
references.pmid: 16100342
references.citation: Ann Intern Med. 2008 Aug 5;149(3):177-84
references.pmid: 18593687
references.citation: Arthritis Rheum. 1988 Mar;31(3):315-24
references.pmid: 3358796
references.citation: N Engl J Med. 2001 Oct 11;345(15):1098-104
references.pmid: 11596589
references.citation: J Rheumatol. 2009 Oct;36(10):2158-63
references.pmid: 19723901
references.citation: Arthritis Rheum. 2005 Jul;52(7):1986-92
references.pmid: 15986370
references.citation: Arthritis Rheum. 2009 Jul;60(7):1884-94
references.pmid: 19565495
references.citation: Lancet Infect Dis. 2004 Dec;4(12):761-76
references.pmid: 15567126
references.citation: Clin Vaccine Immunol. 2010 Dec;17(12):1985-90
references.pmid: 20943878
references.citation: J Rheumatol. 2009 Jun;36(6):1118-25
references.pmid: 19447938
references.citation: Arthritis Rheum. 2008 Jun 15;59(6):762-84
references.pmid: 18512708
references.citation: Arthritis Rheum. 1991 Oct;34(10):1218-27
references.pmid: 1930310
references.citation: J Rheumatol. 2007 Aug;34(8):1670-3
references.pmid: 17611987
references.citation: Lancet. 2002 Apr 6;359(9313):1187-93
references.pmid: 11955536
references.citation: Ann Rheum Dis. 2010 Mar;69(3):522-8
references.pmid: 19854715
references.citation: Lancet. 2002 May 4;359(9317):1541-9
references.pmid: 12047962
references.citation: Arthritis Rheum. 2004 Feb;50(2):372-9
references.pmid: 14872478
references.citation: BMC Immunol. 2009 May 28;10:31
references.pmid: 19476627
references.citation: Arthritis Rheum. 2003 Aug;48(8):2122-7
references.pmid: 12905464
references.citation: Eur Respir J. 2010 Nov;36(5):1185-206
references.pmid: 20530046