Incidence of tuberculosis in patients receiving tumor necrosis factor-α blockers
Abstract
Introduction: tuberculosis (TB) is a frequent complication in patients receiving tumor necrosis factor-alpha (TNF-a) blockers. It occurs upon the reactivation of a latent infection or the progression of a recent infection.
Objective: to learn about the incidence of TB in a population receiving tumor necrosis factor-alpha (TNF-a) blockers, to analyze the presentation of this condition and to conduct a latent infection research prior to the initiation of therapy.
Method: retrospective cohort study. Patients receiving tumor necrosis factor-alpha (TNF-a) blockers between 2010 and 2016 were included in the study. Data were obtained from the IT systems of the National Resources Fund and the National Tuberculosis Program. The incidence of TB was calculated and the cases developing TB were described.
Results: 991 treatments were included for 980 patients in total. 9 cases of TB were reported. Global incidence was 419.9 (IC 95% 191.9-591.2) out of 100,000 people per year. Cases of TB were only seen in patients treated with adalimumab. Screening for LTBI upon initiation of the drug was heterogeneous and the disseminated forms of TB prevailed (6/9) over isolated pulmonary affectation (3/9). In all cases anti- TNFa was suspended when TB was diagnosed, and it was not reinitiated.
Conclusions: the incidence of TB in patients receiving tumor necrosis factor-alpha (TNF-a) blockers was 16.5 times greater than in the general population. Disseminated forms of TB prevailed, and some cases occurred in individuals who had received LTBI therapy prior to the initiation of the drug, suggesting the risk persists as long as there is exposure to the drug.
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