Anti-Tumor Necrosis Factor Alpha Treatment and Tuberculin Skin Test

Abstract

Purpose: The use of anti-tumor necrosis factor alpha (anti-TNF) drugs has been a milestone in the treatment of rheumatic diseases. Despite their strong efficacy, there are some factors restricting the use of anti-TNF agents. We must be careful especially for the granulomatous diseases which can be seen endemic in our country such as tuberculosis and leishmaniasis. In our country according to the RAED 2005 Consensus Meeting Reports, patients candidate for anti-TNF treatment are evaluated for both active and inactive tuberculosis before treatment and prophylaxis with isoniazid (INH) has been performed where indicated.

Material and Methods: Tuberculin skin tests (TST) of 43 patients followed up in the Rheumatology Clinic and receiving anti-TNF therapy were repeated under treatment. Patients' pretreatment first TST results, drugs they used, INH prophylaxis state, smoking status and the duration of anti-TNF treatment were evaluated.

Results: 14 patients (32.6%) were women, while 29 (67.4%) were men. The mean of first TST values were 11.72 +/- 90.3 mm (0-30) and the mean of second TST values were 12.06 +/- 12.4 mm (0-45). 48.8% of the patients were smoking and 74.4% of the patients had received INH prophylaxis for 9 months. The mean total duration of anti-TNF drug use was found as 22.67 +/- 19.11 (5-68) months. No statistically significant difference (p=0.888) was observed between the first pretreatment and second under treatment TST results of the patients.

Discussion: Tuberculosis remains to be a serious public health problem for both our country and the whole world. For this reason in our country, a detailed assessment is performed for all patients before anti-TNF treatment. In our study patients who are planned to start anti-TNF therapy were assessed with their first TST values and INH prophylaxis were given to 32 patients (74.4%) before treatment. No statistically significant difference was observed between pre and post-treatment TST values when control TST were performed with the earliest after five months of treatment. These findings may suggest that there is no evident increase in the risk of tuberculosis for patients receiving anti-TNF treatment with appropriate INH prophylaxis.