title: Re-initiation of biologics after the development of tuberculosis under anti-TNF therapy.
abstract: The use of anti-TNF agents is associated with an increased risk of tuberculosis (TB) and anti-TNF agents are stopped when active TB develops. However, discontinuation of treatment can result in flare of the underlying disease. The charts of 22 patients who developed active TB among a cohort of 2754 patients using anti-TNF agents between 2001 and 2013 were reviewed retrospectively. Patients restarting biologics during further follow-up were identified. One patient with miliary TB died within 1 month. A biologic agent was restarted in 16 of the remaining 21 patients (76 %). The most frequently re-initiated biologic agent was etanercept (n = 6) followed by rituximab (n = 5) and interferon-alpha (n = 3). Biologic treatment was re-initiated during anti-TB treatment in four patients and after completing TB treatment in 12 patients. The median follow-up after restarting biologics was 53 (IQR: 40-75) months. TB re-occurred in one patient with Behçet's syndrome, who initially received etanercept due to severe sight-threatening uveitis at the third month of anti-TB treatment followed by canakinumab 15 months later along with methotrexate, cyclosporine and corticosteroids. After a second course of 9 months TB therapy this patient is currently stable on interferon-alpha for 33 months. Restarting of anti-TNF agents and other biologic agents, even during TB treatment, seems to be possible among patients who had previously developed TB under anti-TNF treatment. However, the risk of re-development of TB infection mandates careful follow-up.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey.
authors.forename: Yesim
authors.initials: Y
authors.lastname: Ozguler
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey.
authors.forename: Gulen
authors.initials: G
authors.lastname: Hatemi
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey.
authors.forename: Serdal
authors.initials: S
authors.lastname: Ugurlu
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey.
authors.forename: Emire
authors.initials: E
authors.lastname: Seyahi
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey.
authors.forename: Melike
authors.initials: M
authors.lastname: Melikoglu
authors.affiliation: Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey.
authors.forename: Sermin
authors.initials: S
authors.lastname: Borekci
authors.affiliation: Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey.
authors.forename: Ersan
authors.initials: E
authors.lastname: Atahan
authors.affiliation: Department of Pulmonary Diseases, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey.
authors.forename: Gul
authors.initials: G
authors.lastname: Ongen
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Fatih, Istanbul, 34098, Turkey. vhamuryudan@yahoo.com.
authors.forename: Vedat
authors.initials: V
authors.lastname: Hamuryudan
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001528:Behcet Syndrome / Q000188:drug therapy*; D001688:Biological Products / Q000009:adverse effects* / Q000627:therapeutic use; D000068800:Etanercept / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment; D012189:Retrospective Studies; D000069283:Rituximab / Q000009:adverse effects / Q000627:therapeutic use; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000209:etiology*
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D000069283:Rituximab; D000068879:Adalimumab; D000068800:Etanercept
keywords: Ankylosing spondylitis; Behçet’s syndrome; Mycobacterium tuberculosis; Rheumatoid arthritis; Tumor necrosis factor inhibitors