SAT0402 Leishmaniasis in patients on tumour necrosis factor inhibitors treatment
Authors: L. Montolio Chiva, E. Valls Pascual, D. Ybañez Garcia, A. Martínez Ferrer, M. Fernández Matilla, J. Lluch Pons, X. Juanola Roura, J. Marcoval Caus, M.-I. García Briz, J.M. Paredes Arquiola, I. López Cruz, A. Salazar Cifre, M. Aguilar Zamora, A.V. Orenes Vera, A. Garcia Sendra, V. Núñez Monje, I. Torner Hernández, J.J. Alegre Sancho
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Tumour necrosis factor (TNF) plays a major role in defense against leishmaniasis. Despite wide use of TNFα inhibitor (anti-TNF) for several diseases, leishmaniasis has been a rare infectious complication so far in these patients. Recently, an increased incidence has been noted. <h3>Objectives</h3> To describe a recent multicenter case series of leishmaniasis in patients with chronic inflammatory diseases treated with anti-TNF. <h3>Methods</h3> We reviewed the clinical history of a multicentric series of patients with chronic inflammatory diseases treated with anti-TNF, who were diagnosed with leishmaniasis between <sup>January 2013</sup> and December 2017. Patients came from Rheumatology, Digestive and Dermatology departments of several hospitals in Valencia<sup>2</sup> and Cataluña<sup>1</sup> region. Demographic (age, sex) and clinical (inflammatory disease, comorbidities, current treatment, year of infection and leishmaniasis form) variables were collected. Anti-TNF withdraw, subsequent reintroduction and recurrence rate were recorded in two hospitals. Biologic drug dispensation trends from 2013 to 2016 and epidemiological data published by <i>the Regional Ministry of Health of Valencia</i> for the area where cases were most incident were analysed. <h3>Results</h3> 25 cases of leishmaniasis in patients treated with immunomodulators were identified:7 on DMARD, 1 on tocilizumab and 17 on anti-TNF (7 infliximab, 4 adalimumab, 3 golimumab, 2 certolizumab, 1 etanercept). Regarding patients on anti-TNF, 2 cases were collected in 2014, 4 in 2015, 4 in 2016 and 7 in 2017. Three patients developed the visceral form, 13 the cutaneous form and 1 presented visceral and cutaneous involvement. Seven patients were males and 10 females, with an average age of 50 (SD14) years. One patient presented rheumatoid arthritis, 4 psoriatic arthritis, 1 undifferentiated spondyloarthropathy, 2 ankylosing spondylitis, 1 uveitis, 6 Crohn's disease and 2 ulcerative colitis. Six patients presented other chronic disease (1 latent tuberculosis, 1 pyoderma gangrenosum, 1 psoriasis and 3 diabetes mellitus). In two hospitals (15 patients), anti-TNF treatment was withdrawn in 10 cases, and it was reintroduced after treating the infection in 5 cases. No infection recurrences have been indentified. Focusing on the area with the highest incidence of cases, despite the increase in anti-TNF use over the last years, its consumption was not parallel to the rise of leishmaniasis cases reported. <h3>Conclusions</h3> the disproportionate increase of leishmaniasis cases in patients with anti-TNF suggests the necessity to investigate and control other possible factors involved. <h3>Disclosure of Interest</h3> None declared