AB1231 INCIDENCE OF TUBERCULOSIS IN PATIENTS WITH RHEUMATIC DISEASES USING TNF INHIBITORS: A SYSTEMATIC REVIEW
Authors: Natália Sartori, Nicole Andrade, Rafael Chakr
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> The TNF inhibitors (anti-TNF) are indicated for the treatment of several rheumatic diseases, but their use is associated with an increased risk of tuberculosis. Many measures of preventive measures have been adopted, but some groups of patients appear to be at greater risk of developing infection. <h3>Objectives:</h3> The primary objective is to estimate the incidence of tuberculosis in patients with rheumatologic diseases exposed to anti-TNF. The secondary objectives are to evaluate the incidence of tuberculosis by region and subgroups of diseases, to assess the presentation of tuberculosis in these patients and the time elapsed between onset of anti-TNF and the development of active granulomatous disease. <h3>Methods:</h3> A systematic review of the literature was conducted in Medline (Pubmed, Embase), Cochrane Library and Lilacs with inclusion of observational studies. The selection of articles was performed by two independent reviewers and the disagreements were resolved by consensus. The primary endpoint was described in measure of incidence and secondary outcomes through subgroup analyzes and means comparisons. <h3>Results:</h3> We included 54 observational studies with a total of 98,483 patients exposed to anti-TNF. Among the exposed patients, 947 cases of tuberculosis were documented (pulmonary form in 62.2% of cases), with a cumulative incidence of 9.62 cases per 1,000 patients exposed [CI: 9.01 - 10.23]. Regarding TB incidence considering the different continents, we found the following distribution: South America with 11.75 per 1,000 patients exposed [CI: 7.17 - 16.33], North America with 4.34 per 1,000 patients exposed [CI: 3.31-5.38], Europe with 6.28 per 1,000 patients exposed [CI: 5.34 - 7.14] and Asia with 13.47 patients per 1,000 exposed [CI: 12.44 - 14.49]. There were no significant differences in TB incidence among the described diseases (rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis). The mean time of use of the medication until the endpoint was 14.49 months. <h3>Conclusion:</h3> The overall incidence of TB in individuals with rheumatic diseases using anti-TNF was 9.62 cases/103 patient-years, being higher in South America and Asia compared to North America and Europe. Most cases occurred in the first XX months of use and the predominant form was pulmonary. There were no differences in incidence between diseases. <h3>References</h3> [1] Pérez-Sola MJ, Torre-Cisneros J, Pérez-Zafrilla B, Carmona L, Descalzo MA, Gómez-Reino JJ. Infections in patients treated with tumor necrosis factor antagonists: incidence, etiology and mortality in the BIOBADASER registry. Med Clin (Barc). 2011; [2] Yonekura CL, Oliveira RDR, Titton DC, et al. Incidência de tuberculose em pacientes com artrite reumatoide em uso de bloqueadores do TNF no Brasil: dados do Registro Brasileiro de Monitoração de Terapias Biológicas BiobadaBrasil. Rev Bras Reumatol. 2017; [3] Dixon WG, Hyrich KL, Watson KD, et al. Drug-specific risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: Results from the British Society for Rheumatology Biologics Register (BSRBR). Ann Rheum Dis. 2010; [4] 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; [5] Lee SK, Kim SY, Kim EY, et al. Mycobacterial infections in patients treated with tumor necrosis factor antagonists in South Korea. Lung. 2013. <h3>Disclosure of Interests:</h3> None declared