Abstract
Background. The new class of drugs - biologics (B) - is high effective, but its essential effect is to increase (in different degree) the risk of tuberculosis (TB).
Methods. 600 pts (rheumatoid arthritis - 264, ankylosing spondylitis - 257, psoriasis - 50, other - 29), 303 male and 297 female, 15-80 y.o. (95%CI 42,2, 43,3) were examined before (377 pts) and during (286 pts: infliximab - 159, adalimumab - 58, etanercept - 17, certolizumab - 12, rituximab - 28, abatacept - 11, tocilizumab - 21; 20 pts receive more then one B consecutively) B treatment. Clinical examination, X-ray (CT in any abnormalities), tuberculin skin test (TST), interferon-gamma release assays (IGRA), skin test with recombinant protein ESAT-6/CFP-10 (developed in Russia as DIASKINTEST - DST) were performed.
Results. In all cases by primary screening active TB was rejected, but positive TST was obtained in 82,6%, IGRA - in 34,4% and DST - in 25,8%. Preventive TB treatment (PT) was administrated in patients with residual TB changes (49) or defined latent TB infection (LTB) (positive both NST and IGRA/DST). During the B treatment active pulmonary TB was detected in 8 pts (all - on TNF-alpha inhibitors): in 2 active or LTB was rejected after screening, in 6 - the TB-screening was insufficient. Especially problem was to consider the LTB in patients with TST conversion from negative to positive (63 pts), but new tests were positive only in the one third of such cases (IGRA - 35%, DST - 33,3%).
Conclusion. The procedure of TB screening and monitoring is the essential part of the B treatment program. The tests based on specific M.tuberculosis antigens are very useful as the tools for LTB monitoring and enable to reduce PT at least three times.
- © 2012 ERS
