Safety of Resuming Tumor Necrosis Factor Inhibitors in Ankylosing Spondylitis Patients Concomitant with the Treatment of Active Tuberculosis: A Retrospective Nationwide Registry of the Korean Society of Spondyloarthritis Research.
Patients who develop an active tuberculosis infection during tumor necrosis factor (TNF) inhibitor treatment typically discontinue TNF inhibitor and receive standard anti-tuberculosis treatment. However, there is currently insufficient information on patient outcomes following resumption of TNF inhibitor treatment during ongoing anti- tuberculosis treatment. Our study was designed to investigate the safety of resuming TNF inhibitors in ankylosing spondylitis (AS) patients who developed tuberculosis as a complication of the use of TNF inhibitors.



Through the nationwide registry of the Korean Society of Spondyloarthritis Research, 3929 AS patients who were prescribed TNF inhibitors were recruited between June 2003 and June 2014 at fourteen referral hospitals. Clinical information was analyzed about the patients who experienced tuberculosis after exposure to TNF inhibitors. The clinical features of resumers and non-resumers of TNF inhibitors were compared and the outcomes of tuberculosis were surveyed individually.



Fifty-six AS patients were treated for tuberculosis associated with TNF inhibitors. Among them, 23 patients resumed TNF inhibitors, and these patients were found to be exposed to TNF inhibitors for a longer period of time and experienced more frequent disease flare-up after discontinuation of TNF inhibitors compared with those who did not resume. Fifteen patients resumed TNF inhibitors during anti-tuberculosis treatment (early resumers) and 8 after completion of anti-tuberculosis treatment (late resumers). Median time to resuming TNF inhibitor from tuberculosis was 3.3 and 9.0 months in the early and late resumers, respectively. Tuberculosis was treated successfully in all resumers and did not relapse in any of them during follow-up (median 33.8 [IQR; 20.8-66.7] months).



Instances of tuberculosis were treated successfully in our AS patients, even when given concomitantly with TNF inhibitors. We suggest that early resumption of TNF inhibitors in AS patients could be safe under effective coverage of tuberculosis.
Department of Internal Medicine, Yonsei University College of Medicine, Division of Rheumatology, Gangnam Severance Hospital, Seoul, Korea.
Hye Won
HW
Kim
Division of Rheumatology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
Seong Ryul
SR
Kwon
Division of Rheumatology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
Kyong-Hee
KH
Jung
Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea.
Seong-Kyu
SK
Kim
Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea.
Han Joo
HJ
Baek
Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea.
Mi Ryung
MR
Seo
Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
So-Young
SY
Bang
Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
Hye-Soon
HS
Lee
Division of Rheumatology, Department of Internal Medicine, Ajou University Hospital, Suwon, Korea.
Chang-Hee
CH
Suh
Division of Rheumatology, Department of Internal Medicine, Ajou University Hospital, Suwon, Korea.
Ju Yang
JY
Jung
Division of Rheumatology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
Chang-Nam
CN
Son
Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
Seung Cheol
SC
Shim
Department of Rheumatology, Center of Arthritis and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
Sang-Hoon
SH
Lee
Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
Seung-Geun
SG
Lee
Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical center, Seoul, Korea.
Yeon-Ah
YA
Lee
Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Eun Young
EY
Lee
Division of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Tae-Hwan
TH
Kim
Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Yong-Gil
0000-0002-8029-7355
YG
Kim
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000188:drug therapy*; D014376:Tuberculosis / Q000150:complications*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D014409:Tumor Necrosis Factor-alpha