J Korean Med Sci.  2014 Jan;29(1):38-42. 10.3346/jkms.2014.29.1.38.

Safe Re-administration of Tumor Necrosis Factor-alpha (TNFalpha) Inhibitors in Patients with Rheumatoid Arthritis or Ankylosing Spondylitis Who Developed Active Tuberculosis on Previous Anti-TNFalpha Therapy

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea. chyoon@catholic.ac.kr

Abstract

There is no consensus on whether it is safe to re-administer tumor necrosis factor-alpha (TNFalpha) inhibitors in patients with rheumatoid arthritis (RA) or ankylosing spondylitis (AS) flared after withdrawal of TNFalpha inhibitors due to active tuberculosis (TB). We evaluated the safety of restarting anti-TNFalpha therapy in patients with TNFalpha-associated TB. We used data of 1,012 patients with RA or AS treated with TNFalpha inhibitors at Seoul St. Mary's Hospital between January 2003 and July 2013 to identify patients who developed active TB. Demographic and clinical data including the results of tuberculin skin tests (TST) and interferon-gamma releasing assays (IGRA) were collected. Fifteen patients developed active TB. Five cases were occurred in RA and 10 cases in AS. Nine of 15 patients had a negative TST or IGRA and 6 TST-positive patients had received prophylaxis prior to initiating anti-TNFalpha therapy. All patients discontinued TNFalpha inhibitors with starting the treatment of TB. Eight patients were re-administered TNFalpha inhibitors due to disease flares and promptly improved without recurrence of TB. TNFalpha inhibitors could be safely resumed after starting anti-TB regimen in patients with RA or AS.

Keyword

TNFalpha Inhibitor; Tuberculosis; Arthritis, Rheumatoid; Spondylitis, Ankylosing

MeSH Terms

Adult
Aged
Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use
Antibodies, Monoclonal/adverse effects/therapeutic use
Antibodies, Monoclonal, Humanized/adverse effects/therapeutic use
Antirheumatic Agents/adverse effects/therapeutic use
Arthritis, Rheumatoid/*drug therapy
Enzyme Inhibitors/adverse effects/therapeutic use
Female
Humans
Hydroxychloroquine/adverse effects/therapeutic use
Immunoglobulin G/adverse effects/therapeutic use
Immunosuppressive Agents/adverse effects/*therapeutic use
Interferon-gamma Release Tests
Male
Methotrexate/adverse effects/therapeutic use
Middle Aged
Mycobacterium tuberculosis/isolation & purification
Receptors, Tumor Necrosis Factor/therapeutic use
Retrospective Studies
Spondylitis, Ankylosing/*drug therapy
Tuberculin Test
Tuberculosis/*chemically induced/microbiology
Tumor Necrosis Factor-alpha/*antagonists & inhibitors
Anti-Inflammatory Agents, Non-Steroidal
Antibodies, Monoclonal
Antibodies, Monoclonal, Humanized
Antirheumatic Agents
Enzyme Inhibitors
Hydroxychloroquine
Immunoglobulin G
Immunosuppressive Agents
Methotrexate
Receptors, Tumor Necrosis Factor
Tumor Necrosis Factor-alpha
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