title: Tuberculosis in anti-TNF-α treated patients remains a problem in countries with an intermediate incidence: analysis of 25 patients matched with a control population.
abstract: OBJECTIVE
  An increased incidence of tuberculosis (TB) in patients under anti-TNF-α therapy has been reported, but outcome compared with TB in the general population are unknown.
  
  
  METHODS
  Patients who had active tuberculosis while taking anti-TNF-α drugs were studied and compared with a control group of community-acquired TB matched for sex, age and data of TB.
  
  
  RESULTS
  Twenty-five cases of TB were reported from a cohort of 765 patients under anti-TNF-α from 2001 to 2012. The incidence of TB per 100,000 patient-years was estimated to be 1337, 792 and 405 respectively for those on infliximab, adalimumab and etanercept. Twelve patients had inflammatory bowel disease, ten had rheumatologic diseases and three had psoriasis. From the 17 patients screened for latent TB before anti-TNF-α, three were treated with isoniazid. TB was diagnosed 1-108 months after starting anti-TNF-α, being the median time six, seven and 89 months respectively for those on infliximab, adalimumab and etanercept. Sixty per cent of the cases had extra-pulmonary TB. No deaths occurred in the case groups, while two died in control TB patients. Patients on anti-TNF-α drugs had more frequent extra-pulmonary TB, fever on presentation, higher mean C-reactive protein and lower positive rate of acid-fast bacilli.
  
  
  CONCLUSIONS
  TB may still occur in those with negative testing, some of them probably representing new infections instead of reactivations. Three out of 25 patients had TB in spite of previously treated LTB, although, the outcome of TB was not worse than in the general population.
authors.affiliation: Department of Infectious Diseases, Faculty of Medicine, Centro Hospitalar S. João, Porto, Portugal; Nephrology Research and Development Unit, University of Porto, Portugal.
authors.forename: Cândida
authors.initials: C
authors.lastname: Abreu
authors.forename: Fernando
authors.initials: F
authors.lastname: Magro
authors.forename: João
authors.initials: J
authors.lastname: Santos-Antunes
authors.forename: Artur
authors.initials: A
authors.lastname: Pilão
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rodrigues-Pinto
authors.forename: José
authors.initials: J
authors.lastname: Bernardes
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bernardo
authors.forename: Sofia
authors.initials: S
authors.lastname: Magina
authors.forename: Filipe
authors.initials: F
authors.lastname: Vilas-Boas
authors.forename: Susana
authors.initials: S
authors.lastname: Lopes
authors.forename: Guilherme
authors.initials: G
authors.lastname: Macedo
authors.forename: António
authors.initials: A
authors.lastname: Sarmento
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000995:Antitubercular Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy; D000069285:Infliximab; D055985:Latent Tuberculosis / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D011565:Psoriasis / Q000188:drug therapy; D018124:Receptors, Tumor Necrosis Factor; D012216:Rheumatic Diseases / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Anti-TNF-α therapy; Latent tuberculosis screening; Tuberculosis