Yıl: 2014 Cilt: 11 Sayı: 1 Sayfa Aralığı: 45 - 52 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists

Öz:
Amaç: Tümör nekrozis faktör- α (TNF-α) ankilozan spondilit (AS), romatoid artrit (RA) ve ps öriatik artrit(PsA) gibi birçok inflamatuar hastalık patogenezinde rol oynayan bir proinflamatuar sitokindir. Anti-TNF-αtedavisi inflamatuar hastalıkların tedavisinde halen yaygın olarak kullanılmaktadır. Anti-TNF-α tedavisialan hastalarda tüberküloz ve bazı fırsatçı enfeksiyonların sıklığının arttığı bildirilmiştir. Bu çalışmada anti-TNF- α ajanları ile tedavi edilen hastalarda latent tüberküloz prevalansının araştırılması amaçlanmıştır.Materyal ve Metod: Çalışmaya Romatoloji polikliniğine başvuran ve anti-TNF-α tedavisi alan 83 hastaçalışmaya dahil edildi. Hastalara yapıldı ve akciğer grafisi çekildi.5 mm ve üzeri tuberkülin cilt testi (PPD)endurasyon saptanan hastalar latent tüberküloz olarak kabul edildi. Latent tüberküloz saptanan hastalaraizoniazid (INH) tedavisi 300 mg/gün olarak başlandı ve 9 ay sürdürüldü.Bulgular: Çalışmaya alınan 83 hastanın (25 kadın, 58 erkek) yaş ortalamaları 37,59±10,80 yıl olup,ortalama hastalık süresi 9,82 ± 7,08 yıl idi. Primer hastalık olarak AS (n=62), RA (n=16) ve PsA (n=5)mevcuttu. Hastalar farklı anti-TNF- α ajanlar (etanercept n=30, adalimumab n=30, infliksimab n=21 vegolimumab n=2) ile tedavi edilmişlerdi.PPD 83 hastanın 63'ünde (% 76) 5 mm ve üzeri olarak tespit edildi.INH profilaksisi PPD 5 mm'nin altında olup sağlık çalışanı olmak, geçirilmiş ile mikobakterium tüberkülozisenfeksiyon veya aile öyküsü gibi artmış tüberküloz riski olan 13 hastanın da dahil olduğu 76 hastayabaşlandı. endurasyonu ≥5 mm olan erkek hasta mevcudiyeti (%76) kadınlardan (%24) istatistiksel PPDolarak anlamlı derecede yüksek bulunmuştur (). p=0,026PPD endurasyonunun PPD ≥5 mm olduğu olgularda AS varlığı (n=51,%81),endurasyonu <5 mm olanlardan (n=11,%55) istatistiksel olarak anlamlı derecede yüksek bulunmuştur. endurasyonu ≥5 mm olanlarda PPDRA varlığı (n=8, %13) PPD endurasyonu <5 mm olanlardan (n=8, %40) istatistiksel olarak anlamlı derecededüşük bulunmuştur (p=0,025). PPD endurasyonu ≥5 mm ve < 5 mm olan hastaların kullandığı anti-TNF-αdağılımında istatistiksel olarak anlamlı farklılık gözlenmemiştir (p=0,369). İnfliximab tedavisi alanhastalarda PPD endurasyonu ≥5mm olanlar diğer ilaç tedavisi alan hasta gruplardan 2,4 kat daha fazlasaptanmıştır.Sonuç: Anti-TNF-α tedavisi bazı romatizmal hastalıkların tedavisinde en etkili yöntemlerdendir. Aktiftüberküloz veya latent tüberkülozun reaktivasyonu anti-TNF-α tedavisi alan hastalarda ciddi birkomplikasyon olarak ortaya çıkar. Bizim hasta populasyonumuzda latent tüberküloz yaygın olup,hastalarımız profilaktik INH tedavisi almışlardı. Anti-TNF-α tedavisi öncesi latent tüberküloz taranması veönleyici tüberküloz tedavisi önemlidir. Bu konuda daha fazla çalışmalara gereksinim vardır.
Anahtar Kelime:

Konular: Cerrahi

Tümör nekrozis faktör alfa antagonistleri ile tedavi edilen hastalarda latent tüberküloz prevelansı değerlendirilmesi

Öz:
Background: Tumor necrosis factor-&#945; (TNF-&#945;) is a proinflammatory cytokine, which plays an importantrole in the pathogenesis of several inflammatory diseases such as ankylosing spondylitis (AS), rheumatoidarthritis (RA) and psoriatic arthritis (PsA). Anti-TNF-&#945; therapy is now widely used for treatment ofinflammatory diseases. An increased incidence of tuberculosis in patients under anti-TNF-&#945; therapy has beenreported. The aim of this study was to investigate the prevalence of latent tuberculosis in patients treated withan anti-TNF-&#945; agent.Methods: Eighty three patients under anti-TNF-&#945; treatment referring to the Rheumatology outpatient clinicenrolled in the study. Tuberculin skin test (PPD) and chest x-ray are performed. An induration of 5 mm ormore is defined as latent tuberculosis. Patients with latent tuberculosis are treated with isoniazid (INH) 300mg/day during 9 months.Results: Mean age of the 83 patients was 37.59±10.80 years; the average duration of illness was 9.82±7.08years. The primary disease was AS (n=62), RA (n=16), and PsA (n=5). The patients were treated withdifferent anti-TNF-&#945; agents (etanercept n=30, adalimumab n=30, infliximab n=21, and golimumab n=2).PPD induration of 5 mm or more was measured in 63 (76%) of 83 patients. INH prophylaxis was started in 76of the patients including 13 patients with PPD induration < 5mm due to increased risk of tuberculosis (familyhistory, working as a health professional, history of infected with mycobacterium tuberculosis). The numberof male patients (76%) with PPD induration 5 mm is significantly higher than the number of female patients &#8805;(24%) with PPD induration 5 mm (p=0.026). The number of patients with AS in patients with PPD &#8805;induration 5 mm (n=51, 81%) is significantly higher than the number of patients with AS in patients with &#8805;PPD induration <5 mm (n=11, 55%) and the presence of RA in patients with PPD induration 5mm (n=8, &#8805;13%) is found significantly lower than in patients with PPD induration <5mm (n=8, 40%) (p=). There is 0.025no statistically significant difference based on used anti-TNF-&#945; between patients with PPD induration 5mm &#8805;and PPD induration <5mm (p=). The rate of PPD induration 5 mm in patients treated with infliximab 0,369&#8805;is found 2.4 times more than the other anti-TNF-&#945; agent.Conclusions: Active tuberculosis or reactivation of latent tuberculosis presents as a serious complication inpatients receiving anti-TNF-&#945; therapy. Latent tuberculosis screening and preventive tuberculosis treatmentis important before the use of anti-TNF-&#945; agent . Further studies on this subject are needed.
Anahtar Kelime:

Konular: Cerrahi
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1) Yun JW, Lim SY, Suh GY, Chung MP, Kim H, Kwon OJ et al. Diagnosis and treatment of latent tuberculosis infection in arthritis patients treated with tumor necrosis factor antagonists in Korea. J Korean Med Sci 2007; 22(5):779-83.
  • 2) Paluch-Oleś J, Magryś A, Kozioł-Montewka M, Koszarny A, Majdan M. Identification of latent tuberculosis infection in rheumatic patients under consideration for treatment with anti-TNF-α agents. Arch Med Sci 2013; 9(1):112-7.
  • 3)Feldmann M, Maini RN. Anti-TNF alpha therapy of rheumatoid arthritis: what have we learned? Annu Rev Immunol 2001; 19:163-96.
  • 4) Kroesen S, Widmer AF, Tyndall A, Hasler P. Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-alpha therapy. Rheumatology (Oxford) 2003; 42(5):617-21.
  • 5) Voulgari PV. Golimumab: a new anti-TNF-alpha agent for rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. Expert Rev Clin Immunol 2010; 6(5):721-33.
  • 6) Schett G, Coates LC, Ash ZR, Finzel S, Conaghan PG. Structural damage in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: traditional views, novel insights gained from TNF blockade, and concepts for the future. Arthritis Res Ther 2011 25; 13 Suppl 1:S4.
  • 7) British Thoracic Society Standards of Care Committee. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. Thorax 2005; 60(10):800-5.
  • 8) Carmona L, Gómez-Reino JJ, Rodríguez-Valverde V, Montero D, Pascual-Gómez E, Mola EM, et al. BIOBADASER Group. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum 2005; 52(6):1766-72.
  • 9) Furst DE, Cush J, Kaufmann S, Siegel J, Kurth R. Preliminary guidelines for diagnosing and treating tuberculosis in patients with rheumatoid arthritis in immunosuppressive trials or being treated with biological agents. Ann Rheum Dis 2002; 61(2):62-3.
  • 10) Gómez-Reino JJ, Carmona L, Valverde VR, Mola EM, Montero MD. BIOBADASER Group. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum 2003; 48(8):2122-27.
  • 11) Gómez-Reino JJ, Carmona L, Angel Descalzo M. BIOBADASER Group. Risk of tuberculosis in patients treated with tumor necrosis factor antagonists due to incomplete prevention of reactivation of latent infection. Arthritis Rheum 2007; 57(5):756-61.
  • 12) Kalfa M, Aksu K. Treatment with tumor necrosis factor-alpha antagonists and infections. RAED Journal 2011; 3(3-4):49-56.
  • 13) Dixon WG, Watson K, Lunt M, Hyrich KL, Silman AJ, Symmons DP. British Society for Rheumatology Biologics Register. Rates of serious infection, including site-specific and bacterial intracellular infection, in rheumatoid arthritis patients receiving anti-tumor necrosis factor therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum 2006; 54(8):2368-76.
  • 14) Hanta I, Ozbek S, Kuleci S, Kocabas A. The evaluation of latent tuberculosis in rheumatologic diseases for anti-TNF therapy: experience with 192 patients. Clin Rheumatol 2008; 27(9):1083-6.
  • 15) Pamuk ON, Yesil Y, Donmez S, Unlu E, Köker IH, Cakir N. The results of purified protein derivative test in ankylosing spondylitis patients: clinical features, HRCT results and relationship with TNF-blocker usage. Rheumatol Int 2008; 29(2):179-83.
  • 16) Kim SY, Park MS, Kim YS, Kim SK, Chang J, Yong D, et al. Tuberculin skin test and boosted reactions among newly employed healthcare workers: an observational study. PLoS One 2013; 8(5):e645-63.
  • 17) Gardam MA, Keystone EC, Menzies R, Manners S, Skamene E, Long R, et al. Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and clinical management. Lancet Infect Dis 2003; 3(3):148-55.
  • 18) Bongartz T, Sutton AJ, Sweeting MJ, Buchan I, Matteson EL, Montori V. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 2006; 295(19):2275-85.
  • 19) Taylor Z, Nolan CM, Blumberg HM; American Thoracic Society; Centers for Disease Control and Prevention; Infectious Diseases Society of America. Controlling tuberculosis in the United States. Recommendations from the American Thoracic Society, CDC, and the Infectious Diseases Society of America. MMWR Recomm Rep 2005; 54(12):1-81.
  • 20) American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. MMWR Recomm Rep 2000; 49(6):1-51.
  • 21) Ozkara Ş, Aktas Z, Ozkan S, Ecevit H. In: Guideline for Tuberculosis Control in Turkey. War With Tuberculosis In Turkey. Republic of Turkey Ministry of Health; April Ankara, Turkey. p.1-22. Available from: http://www.verem.org.tr/pdf/sayfa_1-22.pdf.
  • 22) Demkow U, Broniarek-Samson B, Filewska M, Lewandowska K, Maciejewski J, Zycinska K, et al. Prevalence of latent tuberculosis infection in health care workers in Poland assessed by interferon-gamma whole blood and tuberculin skin tests. J Physiol Pharmacol 2008; 59(6):209-17.
  • 23) Ozsoy S, Akar T, Gumus S, Dinc AH, Demirel B, Safalı M. The Results of Tuberculin Skin Test and the Risk of Tuberculosis in AutopsyWorkers. Turkiye Klinikleri J Med Sci 2010; 30(6):1876-83.
  • 24) Hizel K, Maral I, Karakus R, Aktas F. The influence of BCG immunisation on tuberculin reactivity and booster effect in adults in a country with a high prevalence of tuberculosis. Clin Microbiol Infect 2004; 10(11):980-3.
  • 25) Hamilton CD. Tuberculosis in the cytokine era: what rheumatologists need to know. Arthritis Rheum 2003; 48(8):2085-2091.
  • 26) Keser G, Direskeneli H, Akkoc N, Inanç M, Ozkara S, Ongen G et al. A guide to prevent tuberculosis in patients receiving anti TNF agents. II. Society of Rheumatismal Research and Education Concensus meeting report (Turkish) 2005.
  • 27) Orsi GB, Antoniozzi T, Ortis M, Pippia V, Sernia S. Skin test screening for tuberculosis among healthcare students: a retrospective cohort study. Ann Ig 2013; 25(4):311-15.
  • 28) Laurenti P, Bruno S, Quaranta G, La Torre G, Cairo AG, Nardella P, et al. Tuberculosis in sheltered homeless population of Rome: an integrated model of recruitment for risk management. ScientificWorldJournal 2012; 2012:396302.
  • 29) Horne DJ, Campo M, Ortiz JR, Oren E, Arentz M, Crothers K, et al. Association between smoking and latent tuberculosis in the U.S. population: an analysis of the National Health and Nutrition Examination Survey. PLoS One 2012; 7(11):e49-50.
  • 30) Jiménez-Corona ME, García-García L, DeRiemer K, Ferreyra-Reyes L, Bobadilla-del-Valle M, Cano- Arellano B et al. Gender differentials of pulmonary tuberculosis transmission and reactivation in an endemic area. Thorax 2006; 61(4):348-53.
  • 31) Mugerwa H, Byarugaba DK, Mpooya S, Miremba P, Kalyango JN, Karamagi C, et al. High Prevalence of tuberculosis infection among medical students in Makerere University, Kampala: results of a cross sectional study. Arch Public Health 2013; 71(1):7.
  • 32) Karkucak M, Capkin E, Ozsu S, Nuhoglu I, Erol M, Yilmaz G, et al. An evaluation of the tuberculin skin test for anti TNF alpha prophylaxis in patients with ankylosing spondylitis and rheumatoid arthritis. Bratisl Lek Listy 2010; 111(9):498-501.
  • 33) Hsia EC, Schluger N, Cush JJ, Chaisson RE, Matteson EL, Xu S, et al. Interferon-γ release assay versus tuberculin skin test prior to treatment with golimumab, a human anti- tumor necrosis factor antibody, in patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis. Arthritis Rheum 2012; 64(7):2068-77.
  • 34) Nobre CA, Callado MR, Lima JR, Gomes KW, Martiniano GV, Vieira WP. Tuberculosis infection in rheumatic patients with infliximab therapy: experience with 157 patients. Rheumatol Int 2012; 32(9):2769-75.
  • 35) Callado MR, Lima JR, Nobre CA, Vieira WP. Low prevalence of reactive PPD prior to infliximab use: comparative study on a population sample of Hospital Geral de Fortaleza. Rev Bras Reumatol 2011; 51 (1):40-52.
APA VURAL M, BES C, ERHAN B, GÜNDÜZ B (2014). The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. , 45 - 52.
Chicago VURAL Meltem,BES Cemal,ERHAN BELGİN,GÜNDÜZ Berrin The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. (2014): 45 - 52.
MLA VURAL Meltem,BES Cemal,ERHAN BELGİN,GÜNDÜZ Berrin The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. , 2014, ss.45 - 52.
AMA VURAL M,BES C,ERHAN B,GÜNDÜZ B The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. . 2014; 45 - 52.
Vancouver VURAL M,BES C,ERHAN B,GÜNDÜZ B The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. . 2014; 45 - 52.
IEEE VURAL M,BES C,ERHAN B,GÜNDÜZ B "The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists." , ss.45 - 52, 2014.
ISNAD VURAL, Meltem vd. "The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists". (2014), 45-52.
APA VURAL M, BES C, ERHAN B, GÜNDÜZ B (2014). The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. Harran Üniversitesi Tıp Fakültesi Dergisi, 11(1), 45 - 52.
Chicago VURAL Meltem,BES Cemal,ERHAN BELGİN,GÜNDÜZ Berrin The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. Harran Üniversitesi Tıp Fakültesi Dergisi 11, no.1 (2014): 45 - 52.
MLA VURAL Meltem,BES Cemal,ERHAN BELGİN,GÜNDÜZ Berrin The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. Harran Üniversitesi Tıp Fakültesi Dergisi, vol.11, no.1, 2014, ss.45 - 52.
AMA VURAL M,BES C,ERHAN B,GÜNDÜZ B The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. Harran Üniversitesi Tıp Fakültesi Dergisi. 2014; 11(1): 45 - 52.
Vancouver VURAL M,BES C,ERHAN B,GÜNDÜZ B The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists. Harran Üniversitesi Tıp Fakültesi Dergisi. 2014; 11(1): 45 - 52.
IEEE VURAL M,BES C,ERHAN B,GÜNDÜZ B "The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists." Harran Üniversitesi Tıp Fakültesi Dergisi, 11, ss.45 - 52, 2014.
ISNAD VURAL, Meltem vd. "The assessment of latent tuberculosis prevalence in patients treated with tumor necrosis factor alpha antagonists". Harran Üniversitesi Tıp Fakültesi Dergisi 11/1 (2014), 45-52.