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Safety of resuming biologic DMARDs in patients who develop tuberculosis after anti-TNF treatment.
Semin Arthritis Rheum. 2017 08; 47(1):102-107.SA

Abstract

OBJECTIVES

To estimate the incidence of tuberculosis (TB) in rheumatoid arthritis (RA) patients treated with tumor necrotizing factor inhibitor (TNFI) and evaluate the safety of resuming biologic disease-modifying anti-rheumatic drugs (DMARDs) in patients who developed TB after anti-TNF treatment.

METHODS

We conducted an inception cohort study of RA patients in the Korean Healthcare Claims Database who started TNFI as the first biologic DMARD between January 2009 and December 2013. The incidence rate (IR) of TB was estimated among total TNFI starters and a nested case-control analysis was performed to compare the characteristics of patients who developed TB and those did not. Patients diagnosed with relapsed TB after resuming biologic DMARDs were identified and their features were described.

RESULTS

We included 4638 RA patients who started TNFI, contributing 8542 PYs of follow-up. The IR of TB in TNFI users was 1.10 (CI: 0.86-1.34) per 100 PYs. After the initial 6 months, the IR was highest at 1.56 (CI: 1.02-2.10) and decreased gradually over time. Among the 81 patients who developed TB, 30 patients (37.0%) resumed biologic DMARDs with a mean interval of 3.3 months after TB development. Two cases of TB were detected among 30 patients with an observational period of 45.7 PY.

CONCLUSIONS

The IR of TB in RA patients who started TNFI was 1.10 per 100 PYs. This rate was highest during the first 6 months. Resumption of biologic DMARDs requires careful monitoring for TB relapse.

Authors+Show Affiliations

Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.Department of Information Statistics, Andong National University, Andong-si, South Korea.Division of Pulmonary and Critical Care Medicine, Hanyang University Guri Hospital, Guri-si, South Korea.Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea.Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea; Clinical Research Center for Rheumatoid Arthritis (CRCRA), Seoul, South Korea. Electronic address: sungyk@hanyang.ac.kr.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28216194

Citation

Cho, Soo-Kyung, et al. "Safety of Resuming Biologic DMARDs in Patients Who Develop Tuberculosis After anti-TNF Treatment." Seminars in Arthritis and Rheumatism, vol. 47, no. 1, 2017, pp. 102-107.
Cho SK, Kim D, Won S, et al. Safety of resuming biologic DMARDs in patients who develop tuberculosis after anti-TNF treatment. Semin Arthritis Rheum. 2017;47(1):102-107.
Cho, S. K., Kim, D., Won, S., Han, M., Lee, J., Jang, E. J., Kim, T. H., Bae, S. C., & Sung, Y. K. (2017). Safety of resuming biologic DMARDs in patients who develop tuberculosis after anti-TNF treatment. Seminars in Arthritis and Rheumatism, 47(1), 102-107. https://doi.org/10.1016/j.semarthrit.2017.01.004
Cho SK, et al. Safety of Resuming Biologic DMARDs in Patients Who Develop Tuberculosis After anti-TNF Treatment. Semin Arthritis Rheum. 2017;47(1):102-107. PubMed PMID: 28216194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Safety of resuming biologic DMARDs in patients who develop tuberculosis after anti-TNF treatment. AU - Cho,Soo-Kyung, AU - Kim,Dam, AU - Won,Soyoung, AU - Han,Minkyung, AU - Lee,Jiyoung, AU - Jang,Eun Jin, AU - Kim,Tae-Hyung, AU - Bae,Sang-Cheol, AU - Sung,Yoon-Kyoung, Y1 - 2017/01/18/ PY - 2016/11/01/received PY - 2017/01/05/revised PY - 2017/01/16/accepted PY - 2017/2/22/pubmed PY - 2018/4/25/medline PY - 2017/2/21/entrez KW - Biologic DMARDs KW - Rheumatoid arthritis KW - TNF inhibitor KW - Tuberculosis SP - 102 EP - 107 JF - Seminars in arthritis and rheumatism JO - Semin. Arthritis Rheum. VL - 47 IS - 1 N2 - OBJECTIVES: To estimate the incidence of tuberculosis (TB) in rheumatoid arthritis (RA) patients treated with tumor necrotizing factor inhibitor (TNFI) and evaluate the safety of resuming biologic disease-modifying anti-rheumatic drugs (DMARDs) in patients who developed TB after anti-TNF treatment. METHODS: We conducted an inception cohort study of RA patients in the Korean Healthcare Claims Database who started TNFI as the first biologic DMARD between January 2009 and December 2013. The incidence rate (IR) of TB was estimated among total TNFI starters and a nested case-control analysis was performed to compare the characteristics of patients who developed TB and those did not. Patients diagnosed with relapsed TB after resuming biologic DMARDs were identified and their features were described. RESULTS: We included 4638 RA patients who started TNFI, contributing 8542 PYs of follow-up. The IR of TB in TNFI users was 1.10 (CI: 0.86-1.34) per 100 PYs. After the initial 6 months, the IR was highest at 1.56 (CI: 1.02-2.10) and decreased gradually over time. Among the 81 patients who developed TB, 30 patients (37.0%) resumed biologic DMARDs with a mean interval of 3.3 months after TB development. Two cases of TB were detected among 30 patients with an observational period of 45.7 PY. CONCLUSIONS: The IR of TB in RA patients who started TNFI was 1.10 per 100 PYs. This rate was highest during the first 6 months. Resumption of biologic DMARDs requires careful monitoring for TB relapse. SN - 1532-866X UR - https://www.unboundmedicine.com/medline/citation/28216194/Safety_of_resuming_biologic_DMARDs_in_patients_who_develop_tuberculosis_after_anti_TNF_treatment_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-0172(16)30408-5 DB - PRIME DP - Unbound Medicine ER -