Latent Tuberculosis Infection and Tuberculosis Development in Children Treated with Anti-TNF-α Agents

Abstract

Objective: Tumor necrosis factor-α antagonists (anti-TNF-α) have improved the treatment and prognosis of patients with several rheumatologic diseases resistant to standard therapy. However, patients on anti- TNF-α agents risk various infections, especially tuberculosis (TB). We determined the incidence of latent TB infection (LTBI) and TB development and assess the follow-up protocol of patients using anti-TNF-α therapy. Methods: Children aged under 18 years prescribed an anti-TNF-α agent were included in the study. Patients were evaluated by history, physical examination, tuberculin skin test (TST), chest X-ray, and when required, examination of sputum/early morning gastric aspirates for acid-fast bacilli and chest tomography. A TST ≥10 mm induration for patients with Bacillus Calmette-Guérin (BCG) vaccination was defined as a positive result, whereas a TST ≥5 mm for those without BCG vaccination. Results: This study included 84 (54.2%) females and 71 (45.8%) males with a median age of 12.0 years (8.0-15.0). The most common diagnoses were oligoarticular juvenile idiopathic arthritis (JIA; n=48) and polyarticular JIA (n=38). Eight patients with positive TST results were administered isoniazid prophylaxis. New TB was determined in one patient with polyarticular JIA on infliximab and idiopathic uveitis on adalimumab. The incidence of LTBI and TB development in children on anti-TNF-α was 2.5% and 0.64%, respectively. Conclusion: Patients on anti-TNF-α agents have a risk of TB development. TB disease is more likely to be seen in children on inflixiam and adalimumab on etanercept. It is crucial to assess these patients for TB by a pediatric pulmonologist or infectious disease at three monthly intervals.

Keywords

• anti-tnf alpha
• infliximab
• rheumatological disease
• tuberculosis