Abstract
To investigate the incidence of tuberculosis (TB) among patients who were prescribed Tumor necrosis factor-alpha antagonist (anti- TNF-α) under isoniazid (INH) prophylaxis.
Between February 2008 and January 2015, 110 patients (23 to 77 age) who were prescribed anti-TNF-α in rheumatologic and dermatologic diseases were included. According to guideline, INH prophylaxis was started. In all patients, physical examination, chest X-ray and tuberculin skin test (TST) was performed.
The mean age was 45.1±12,1 and 52.7% (n = 58) were male. The most common diagnosis was rheumatoid arthritis (42.7%) and ankylosing spondylitis (38.2%); Infliximab 37.3% and etanercept 30.9% was given most frequently. 1.8% of the patients had family history of TB. A statistically significant increase was observed in TST follow-up. Initially, patients with negative TST (<5 mm) of 19% TST conversion was observed. Between the TST positive (≥5 mm) and negative groups, there was no significant difference in mean age. TST positivity was significantly higher in males. In TST negative patients, before anti-TNF, the duration of immunosuppressive therapy was higher. INH prophylaxis was given 42.9% of the TST-negative group. 4.4% of those with a positive TST with no INH prophylaxis. Although INH prophylaxis in two patients developed active TB, INH and streptomycin resistance was determined in one patient. Only in one case, Liver enzyme elevation was detected depending on the INH.
During anti-TNF-α treatment, patients should be closely followed up. In immunosuppressive patients, considering the BCG and TST reliability, we think that routine INH prophylaxis should be started.
- Copyright ©ERS 2015
