Analysis of prevention treatment for tuberculosis in tumor necrosis factor antagonist users in some regions of China

doi:10.3969/j.issn.1000-6621.2021.03.006

Abstract

Abstract:

Objective To investigate the prevention treatment for tuberculosis in patients treated with tumor necrosis factor (TNF) antagonists in some areas of China. Methods A total of 981 rheumatoid arthritis (RA) or ankylosing spondylitis (AS) patients treated with etanercept or infliximab from 13 large general hospitals in eastern, central and western China from March 2014 to February 2016 were selected. The clinical data of gender, age, hormone and immunosuppressant use, underlying disease, tuberculosis history, latent tuberculosis infection (LTBI) screening, chest X-ray or CT scan results, prevention treatment of tuberculosis were collected,. The proportion of LTBI and inactive tuberculosis screening, the proportion of prevention treatment for tuberculosis and the treatment regimens in RA or AS patients with TNF antagonist were analyzed. Results Of the 981 subjects, 779 (79.4%) were treated with etanercept and 202 (20.6%) with infliximab. Only 25.7% (252/981) subjects were screened for LTBI, and the positive rate was 18.3% (46/252). And 2.8% (27/981) of the subjects were diagnosed as inactive tuberculosis, of which 19 cases had a history of tuberculosis. Of the 712 patients (72.6%) who underwent chest X-ray and/or CT scan, 13 (1.8%) were reported inactive pulmonary tuberculosis. A total of 15 subjects received TB prevention treatment; 6 (13.0%, 6/46) of the patients complicated with LTBI received tuberculosis preventive treatment; none of the patients diagnosed as inactive tuberculosis received tuberculosis prevention treatment. Among the patients who received tuberculosis prevention treatment, 9 cases (60.0%, 9/15) were treated with isoniazid monotherapy for 1-18 months. Conclusion In some areas of China, the proportion of LTBI screening in RA or AS patients treated with TNF antagonists was low, the proportion of tuberculosis prevention treatment was low, the selection criteria of prevention objects were different, and the prevention scheme was not standardized.

Key words: Tumor necrosis factors, Antistatic agents, Arthritis,rheumatoid, Spondylitis,ankylosing, Tuberculosis, Protective agents

ZHANG Li-fan, MA Hui-min, ZHENG Wen-jie, ZHANG Feng-chun, LIU Xiao-qing. Analysis of prevention treatment for tuberculosis in tumor necrosis factor antagonist users in some regions of China[J]. Chinese Journal of Antituberculosis, 2021, 43(3): 222-227. doi: 10.3969/j.issn.1000-6621.2021.03.006

Figures/Tables 1

References 35

[1]	LoBue PA, Mermin JH. Latent tuberculosis infection: the final frontier of tuberculosis elimination in the USA. Lancet Infect Dis, 2017,17(10):e327-e333. doi: 10.1016/S1473-3099(17)30248-7. doi: 10.1016/S1473-3099(17)30248-7 URL pmid: 28495525
[2]	Seong SS, Choi CB, Woo JH, et al. Incidence of tuberculosis in Korean patients with rheumatoid arthritis (RA): effects of RA itself and of tumor necrosis factor blockers. J Rheumatol, 2007,34(4):706-711. URL pmid: 17309133
[3]	Gómez-Reino JJ, Carmona L, Valverde VR, et al. 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):2122-2127. doi: 10.1002/art.11137. doi: 10.1002/art.11137 URL pmid: 12905464
[4]	Koike R, Takeuchi T, Eguchi K, et al. Update on the Japanese guidelines for the use of infliximab and etanercept in rheumatoid arthritis. Mod Rheumatol, 2007,17(6):451-458. doi: 10.1007/s10165-007-0626-3. doi: 10.1007/s10165-007-0626-3 URL
[5]	Favalli EG, Caporali R, Sinigaglia L, et al. Recommendations for the use of biologic therapy in rheumatoid arthritis: update from the Italian Society for Rheumatology Ⅱ. Safety. Clin Exp Rheumatol, 2011,29(3 Suppl 66):S15-S27. URL pmid: 21906424
[6]	Bombardier C, Hazlewood GS, Akhavan P, et al. Canadian Rheumatology Association recommendations for the pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs: part Ⅱ safety. J Rheumatol, 2012,39(8):1583-1602. doi: 10.3899/jrheum.110207. doi: 10.3899/jrheum.120165 URL
[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):800-805. doi: 10.1136/thx.2005.046797. doi: 10.1136/thx.2005.046797 URL pmid: 16055611
[8]	Beglinger C, Dudler J, Mottet C, et al. Screening for tuberculosis infection before the initiation of an anti-TNF-alpha therapy. Swiss Med Wkly, 2007,137(43/44):620-622.
[9]	Center for Disease Control and Prevention. Latent tuberculosis infection: A guide for primary health care providers[EB/OL].[2021-01-28]. https://www.cdc.gov/tb/publications/ltbi/pdf/ltbibooklet508.pdf.
[10]	Getahun H, Matteelli A, Abubakar I, et al. Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries. Eur Respir J, 2015,46(6):1563-1576. doi: 10.1183/13993003.01245-2015. doi: 10.1183/13993003.01245-2015 URL pmid: 26405286
[11]	肿瘤坏死因子拮抗剂应用中结核病预防与管理专家建议组. 肿瘤坏死因子拮抗剂应用中结核病预防与管理专家共识. 中华风湿病学杂志, 2013,17(8):508-512. doi: 10.3760/cma.j.issn.1007-7480.2013.08.002.
[12]	Roach DR, Bean AG, Demangel C, et al. TNF regulates chemokine induction essential for cell recruitment, granuloma formation, and clearance of mycobacterial infection. J Immunol, 2002,168(9):4620-4627. doi: 10.4049/jimmunol.168.9.4620. doi: 10.4049/jimmunol.168.9.4620 URL pmid: 11971010
[13]	Vila-del Sol V, Díaz-Muñoz MD, Fresno M. Requirement of tumor necrosis factor alpha and nuclear factor-kappaB in the induction by IFN-gamma of inducible nitric oxide synthase in macrophages. J Leukoc Biol, 2007,81(1):272-283. doi: 10.1189/jlb.0905529. URL pmid: 17035338
[14]	Nocturne G, Boudaoud S, Pascaud J, et al. Impact of anti-TNF therapy on NK cells function and on immunosurveillance against B-cell lymphomas. J Autoimmun, 2017,80:56-64. doi: 10.1016/j.jaut.2017.02.001. doi: 10.1016/j.jaut.2017.02.001 URL pmid: 28214146
[15]	Miller EA, Ernst JD. Anti-TNF immunotherapy and tuberculosis reactivation: another mechanism revealed. J Clin Invest, 2009,119(5):1079-1082. doi: 10.1172/jci39143. doi: 10.1172/jci39143 URL pmid: 19422095
[16]	Wolfe F, Michaud K, Anderson J, et al. Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy. Arthritis Rheum, 2004,50(2):372-379. doi: 10.1002/art.20009. doi: 10.1002/art.20009 URL pmid: 14872478
[17]	Wallis RS, Broder M, Wong J, et al. Granulomatous infections due to tumor necrosis factor blockade: correction. Clin Infect Dis, 2004,39(8):1254-1255. doi: 10.1086/424455. doi: 10.1086/424455 URL pmid: 15486857
[18]	Askling J, Fored CM, Brandt L, et al. Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum, 2005,52(7):1986-1992. doi: 10.1002/art.21137. doi: 10.1002/art.21137 URL pmid: 15986370
[19]	Wang Q, Wen Z, Cao Q. Risk of tuberculosis during infliximab therapy for inflammatory bowel disease, rheumatoid arthritis, and spondyloarthropathy: A meta-analysis. Exp Ther Med, 2016,12(3):1693-1704. doi: 10.3892/etm.2016.3548. doi: 10.3892/etm.2016.3548 URL pmid: 27588089
[20]	Maini R, St Clair EW, Breedveld F, et al. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody)versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomized phase Ⅲ trial. ATTRACT Study Group. Lancet, 1999,354(9194):1932-1939. doi: 10.1016/s0140-6736(99)05246-0. doi: 10.1016/s0140-6736(99)05246-0 URL pmid: 10622295
[21]	Carmona L, Gómez-Reino JJ, Rodríguez-Valverde V, et al. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum, 2005,52(6):1766-1772. doi: 10.1002/art.21043. doi: 10.1002/art.21043 URL pmid: 15934089
[22]	World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management: annex 3: values and preferences for the management of latent tuberculosis infection: survey of populations affected by the recommendations. Geneva: World Health Organization, 2018.
[23]	边赛男, 刘晓清. γ-干扰素释放试验在免疫功能抑制人群中诊断结核分枝杆菌感染的应用. 中华实验和临床感染病杂志(电子版), 2017,11(2):117-120. doi: 10.3877/cma.j.issn.1674-1358.2017.02.003.
[24]	Grzybowski S, Fishaut H, Rowe J, et al. Tuberculosis among patients with various radiologic abnormalities, followed by the chest clinic service. Am Rev Respir Dis, 1971,104(4):605-608. doi: 10.1164/arrd.1971.104.4.605. doi: 10.1164/arrd.1971.104.4.605 URL pmid: 5094062
[25]	Nolan CM, Elarth AM. Tuberculosis in a cohort of Southeast Asian Refugees. A five-year surveillance study. Am Rev Respir Dis, 1988,137(4):805-809. doi: 10.1164/ajrccm/137.4.805. doi: 10.1164/ajrccm/137.4.805 URL pmid: 3354985
[26]	This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. This is a Joint Statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC). This statement was endorsed by the Council of the Infectious Diseases Society of America. (IDSA), September 1999, and the sections of this statement. Am J Respir Crit Care Med, 2000,161(4 Pt 2):S221-S247. doi: 10.1164/ajrccm.161.supplement_3.ats600. doi: 10.1164/ajrccm.161.supplement_3.ats600 URL pmid: 10764341
[27]	Zhang CY, Zhao F, Xia YY, et al. Prevalence and risk factors of active pulmonary tuberculosis among elderly people in China: a population based cross-sectional study. Infect Dis Poverty, 2019,8(1):7. doi: 10.1186/s40249-019-0515-y. doi: 10.1186/s40249-019-0515-y URL pmid: 30654836
[28]	Xin H, Zhang H, Yang S, et al. 5-Year follow-up of active tuberculosis development from latent infection in rural China. Clin Infect Dis, 2020,70(5):947-950. doi: 10.1093/cid/ciz581. doi: 10.1093/cid/ciz581 URL pmid: 31253988
[29]	Gao L, Zhang H, Xin H, et al. Short-course regimens of rifapentine plus isoniazid to treat latent tuberculosis infection in older Chinese patients: a randomised controlled study. Eur Respir J, 2018,52(6):1801470. doi: 10.1183/13993003.01470-2018. doi: 10.1183/13993003.01470-2018 URL pmid: 30361241
[30]	Gao L, Li X, Zhang H, et al. Incidence of active tuberculosis in rural China-Authors’ reply. Lancet infect Dis, 2018,18(2):145-146. doi: 10.1016/S1473-3099(18)30022-7. doi: 10.1016/S1473-3099(18)30022-7 URL pmid: 29412964
[31]	Wong SH, Gao Q, Tsoi KK, et al. Effect of immunosuppressive therapy on interferon γ release assay for latent tuberculosis screening in patients with autoimmune diseases: a systematic review and meta-analysis. Thorax, 2016,71(1):64-72. doi: 10.1136/thoraxjnl-2015-207811. doi: 10.1136/thoraxjnl-2015-207811 URL pmid: 26659461
[32]	Puri AS, Desai D, Sood A, et al. Infliximab-induced tuberculosis in patients with UC: Experience from India-a country with high prevalence of tuberculosis. J Gastroenterol Hepatol, 2017,32(6):1191-1194. doi: 10.1111/jgh.13669. doi: 10.1111/jgh.13669 URL pmid: 27893931
[33]	Kedia S, Mouli VP, Kamat N, et al. Risk of tuberculosis in patients with inflammatory bowel disease on infliximab or adali-mumab is dependent on the local disease burden of tuberculosis: a systematic review and meta-analysis. Am J Gastroenterol, 2020,115(3):340-349. doi: 10.14309/ajg.0000000000000527. doi: 10.14309/ajg.0000000000000527 URL pmid: 32032073
[34]	Ye L, Chapman TP, Wen Z, et al. Targeted versus universal tuberculosis chemoprophylaxis in 1968 patients with inflammatory bowel disease receiving anti-TNF therapy in a tuberculosis endemic region. Aliment Pharmacol Ther, 2021,53(3):390-399. doi: 10.1111/apt.16130. doi: 10.1111/apt.16130 URL pmid: 33314259
[35]	World Health Organization. Global tuberculosis report 2020. Geneva: World Health Organization, 2020.

患者序号	性别	年龄 (岁)	诊断	TNF 拮抗剂	应用激素	应用免疫抑制剂	基础病	T-SPOT. TB检测	TST 检测	结核病既往史	非活动性肺结核	预防性治疗方案	总疗程
1	男	50	RA	英夫利西单抗	是	甲氨蝶呤	无	-	-	无	无	异烟肼+ 利福喷丁	2个月
2	女	46	RA	依那西普	是	来氟米特	无	-	-	无	无	异烟肼+ 利福平	8个月
3	女	46	RA	依那西普	是	甲氨蝶呤	无	-	-	无	无	异烟肼	4个月
4	女	61	RA	依那西普	是	甲氨蝶呤; 来氟米特	无	阳性	-	无	无	异烟肼	不详
5	男	53	RA	依那西普	是	甲氨蝶呤; 来氟米特	无	-	-	无	-	异烟肼+ 利福平+ 乙胺丁醇+ 吡嗪酰胺	1个月
6	女	61	RA	依那西普	否	无	糖尿病	-	-	无	无	异烟肼	18个月
7	男	31	AS	依那西普	否	无	无	阳性	-	无	无	异烟肼	1个月
8	男	55	AS	依那西普	否	柳氮磺胺吡啶	无	-	阳性	无	无	异烟肼	不详
9	女	24	AS	依那西普	否	无	无	-	-	无	无	异烟肼	1个月
10	男	53	AS	依那西普	否	无	无	阴性	-	无	无	异烟肼	1个月
11	男	20	AS	依那西普	是	柳氮磺胺吡啶	无	阴性	阳性	无	无	异烟肼	不详
12	女	19	AS	依那西普	是	甲氨蝶呤;柳氮磺胺吡啶	无	-	-	无	无	异烟肼+ 利福平+ 乙胺丁醇+ 吡嗪酰胺	6个月
13	男	45	AS	依那西普	是	柳氮磺胺吡啶	无	-	-	无	-	不详	不详
14	男	33	AS	依那西普	否	甲氨蝶呤;柳氮磺胺吡啶	无	阳性	-	无	无	异烟肼	4个月
15	男	28	AS	依那西普	否	甲氨蝶呤;柳氮磺胺吡啶	无	阳性	-	无	-	异烟肼+ 利福平	24个月