title: Active tuberculosis risk with tumor necrosis factor inhibitors after treating latent tuberculosis.
abstract: BACKGROUND
  Active tuberculosis (TB) risk increases during anti-tumor necrosis factor (TNF) therapy; therefore, latent TB infection (LTBI) screening is recommended in potential TNF inhibitor users. It is unclear whether anti-TNF therapy increases the risk of active TB infection even after standard LTBI treatment.
  
  
  OBJECTIVE
  The objective of this study was to compare the risk of active TB development in LTBI-positive versus LBTI-negative TNF inhibitor users following the current national LTBI treatment guidelines for LTBI.
  
  
  METHODS
  We retrospectively studied 949 TNF inhibitor users with immune-mediated inflammatory diseases from 2005 to 2012 at the Yonsei University Health System. We compared the incidence of active TB among LTBI-positive TNF inhibitor users treated according to national guidelines (n = 256) and LTBI-negative TNF inhibitor users (n = 521), using Poisson regression.
  
  
  RESULTS
  The active TB incidence was 1107 per 100,000 patient-years in LTBI-positive TNF inhibitor users who received standard LTBI treatment and 490 per 100,000 patient-years in LTBI-negative TNF inhibitor users. Analysis showed that despite this numerical trend active TB risk was not statistically significantly elevated in LTBI-positive versus LTBI-negative TNF inhibitor users (incidence risk ratio, 2.15; P = 0.24; 95% confidence interval, 0.6-7.7).
  
  
  CONCLUSIONS
  This study demonstrated no statistically significantly increased risk of active TB in LTBI-positive TNF inhibitor users who received standard LTBI treatment compared with LTBI-negative TNF inhibitor users.
authors.affiliation: From the *Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; †Department of Internal Medicine, William Beaumont Hospital, Royal Oak, MI; and ‡Division of Infectious Disease, Department of Internal Medicine, and §Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Minkyung
authors.initials: M
authors.lastname: Kwon
authors.forename: Mindong
authors.initials: M
authors.lastname: Sung
authors.forename: Yong-Jin
authors.initials: YJ
authors.lastname: Kwon
authors.forename: Young Goo
authors.initials: YG
authors.lastname: Song
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Lee
authors.forename: Min-Chan
authors.initials: MC
authors.lastname: Park
authors.forename: Yong-Beom
authors.initials: YB
authors.lastname: Park
authors.forename: Soo-Kon
authors.initials: SK
authors.lastname: Lee
authors.forename: Jason Jungsik
authors.initials: JJ
authors.lastname: Song
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015994:Incidence; D055985:Latent Tuberculosis / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D012044:Regression Analysis; D056910:Republic of Korea; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000188:drug therapy*; D012307:Risk Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000453:epidemiology* / Q000382:microbiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D000995:Antitubercular Agents; D014409:Tumor Necrosis Factor-alpha