title: Does isoniazid chemoprophylaxis increase the frequency of hepatotoxicity in patients receiving anti-TNF-α agent with a disease-modifying antirheumatic drug?
abstract: OBJECTIVE
  The aim of this study is to determine the incidence of isoniazid (INH)-related hepatotoxicity in patients with rheumatologic diseases receiving tumor necrosis factor-α (TNF-α) antagonists along with a disease-modifying antirheumatic drug (DMARD).
  
  
  METHODS
  We have retrospectively evaluated 87 patients receiving anti-TNFα agents who were followed up between June 2005 and February 2010 at our rheumatology department. Sixty-one of 87 patients have received INH prophylaxis for 9 months for latent tuberculosis infection.
  
  
  RESULTS
  A total of 61 (70.1%) of 87 patients used INH prophylaxis (Group I), while the remaining 26 (29.9%) (Group II) had not; 53 patients had used any DMARD in Group I, while 21 patients had used in Group II. No significant differences were found among Group I and II with respect to clinical features. When two groups were compared, in Group I, elevations of liver enzymes were detected in five patients (8.1%) who had normal baseline values. Among these patients, hepatotoxicity developed in two patients. Hepatotoxicity developed one patient in Group II (p=0.85).
  
  
  CONCLUSIONS
  INH chemoprophylaxis was well tolerated in patients using anti-TNF-α agent and a DMARD. It seems not to be a strong risk factor for hepatotoxicity. However, comorbidities and other drugs used may be additional factors in the elevation of transaminases.
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
authors.forename: Döndü Üsküdar
authors.initials: DÜ
authors.lastname: Cansu
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
authors.forename: Sabri
authors.initials: S
authors.lastname: Güncan
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
authors.forename: N Şule Yaşar
authors.initials: NŞ
authors.lastname: Bilge
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
authors.forename: Timuçin
authors.initials: T
authors.lastname: Kaşifoğlu
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey.
authors.forename: Cengiz
authors.initials: C
authors.lastname: Korkmaz
keywords: Tumor necrosis factor inhibitors; disease-modifying anti rheumatic drug; hepatotoxicity; isoniazid