Incidence of tuberculosis infection in spondyloarthritis patients treated with biological and conventional diseasemodifying anti-rheumatic drugs in an endemic area

• Autor(a) principal: Morsch, André Luís Bittencourt
• Data de Publicação: 2020
• Outros Autores: Henrique, Lilian Rodrigues, Silva, Denise Rossato, Garziera, Giovana, Xavier, Ricardo Machado, Hax, Vanessa, Ferreira, Manoela Fantinel, Kohem, Charles Lubianca, Mancuso, Aline Castello Branco, Gasparin, Andrese Aline, Brenol, Claiton Viegas, Andrade, Nicole Pamplona Bueno de, Menegat, Franciele de Almeida, Viecceli, Daniela, Bohn, Renata, Palominos, Penelope Esther
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFRGS
• Texto Completo: http://hdl.handle.net/10183/213715
• topic: Tuberculose; Espondilite anquilosante; Inibidores do fator de necrose tumoral; Fator de necrose tumoral alfa; Incidência; Spondyloarthritis; Tuberculosis; Anti-TNF therapy; Tumor necrosis factor alpha; Tuberculin skin test

Introduction: Registries of spondyloarthritis (SpA) patients’ follow-up provided evidence that tumor necrosis factor inhibitors (TNFi) increase the incidence of active tuberculosis infection (TB). However, most of these registries are from low burden TB areas. Few studies evaluated the safety of biologic agents in TB endemic areas. This study compares the TB incidence rate (TB IR) in anti-TNF-naïve and anti-TNFexperienced subjects with SpA in a high TB incidence setting. Methods: In this retrospective cohort study, medical records from patients attending a SpA clinic during 13 years (2004 to 2016) in a university hospital were reviewed. The TB IR was calculated and expressed as number of events per 105 patients/year; the incidence rate ratio (IRR) associated with the use of TNFi was calculated. Results: A total of 277 patients, 173 anti-TNF-naïve and 104 anti-TNF-experienced subjects, were evaluated; 35.7% (N = 35) of patients who were prescribed an antiTNF drug were diagnosed with latent tuberculosis infection (LTBI). Total follow-up time (person-years) was 1667.8 for anti-TNF-naïve and 394.9 for anti-TNF-experienced patients. TB IR (95% CI) was 299.8 (37.4-562.2) for anti-TNF naïve and 1012.9 (25.3-2000.5) for anti-TNF experienced subjects. The IRR associated with the use of TNFi was 10.4 (2.3- 47.9). Conclusions: In this high TB incidence setting, SpA patients exposed to anti-TNF therapy had a higher incidence of TB compared to anti-TNF-naïve subjects, although the TB incidence in the control group was significant.