Use of biologic agents and risk of tuberculosis in Brazil, a tuberculosis high-burden country

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Abstract

Background: Brazil is a country with a high burden of tuberculosis (TB). The immunomodulatory effect of biological therapies is associated with an increased risk of infection. This study evaluated the frequency of TB infection in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and psoriatic arthritis (PsA) after the use of biologic agents in a single center of rheumatology.

Methods: In this observational study, 161 consecutive adult patients with RA, JIA, AS, and PsA using biological therapy were followed up during 55 months to evaluate the occurrence of TB infection throughout treatment. All patients were screened for latent TB infection (LTBI), and TB disease was excluded before introduction of biological therapy. Patients with LTBI received prophylaxis with isoniazid before the start of biological treatment.

Results: Of 161 patients on biologics, 31 (19.25%) had positive tuberculin skin test (TST) and received LTBI treatment. Eleven (6.8%) cases of TB were detected in patients on biologics, six (54.5%) had AS, one had PsA (9.09%), two had RA (18.18%), and two had JIA (18.18%). Regarding the use of different biologics, six (54.5%) patients received adalimumab, three (27.2%) infliximab, one (9.09%) etanercept, and one (9.09%) tocilizumab.

Conclusion: In this study, the frequency of TB infection among 161 patients on biologics, during 55 months of follow-up, was 6.8%. Compared with the national registry of patients receiving biologics (BiobadaBrasil — January 01, 2009 to May 31, 2013), a higher incidence of TB (6.8 versus 0.44%) was found in this sample of patients receiving biological therapy. This study highlights that in a country with high TB burden, the possibility of TB infection in a patient receiving biological therapy should always be considered, even after prophylaxis with isoniazid.

Keywords: biological therapy, immunomodulation, latent, tuberculosis, tumor necrosis factor inhibitors.

Citation: Chaer FGG, Valim JML, Reis RC, Klautau GB, Souza BDB. Use of biologic agents and risk of tuberculosis in Brazil, a tuberculosis high-burden country. Drugs in Context 2020; 9: 212598. DOI: 10.7573/dic.212598

Contributions: All authors contributed equally to the preparation of this review. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/07/dic.212598-COI.pdf

Acknowledgements: Editorial assistance was provided by Content Ed Net, Madrid, Spain.

Funding declaration: Editorial assistance was funded by UCB Brazil.

Copyright: Copyright © 2020 Chaer FGG, Valim JML, Reis RC, Klautau GB, Souza BDB. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Chaer FGG, Valim JML, Reis RC, Klautau GB, Souza BDB. https://doi.org/10.7573/dic.212598. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/use-of-biologic-agents-and-risk-of-tuberculosis-in-brazil,-a-tuberculosis-high-burden-country

Correspondence: FGG Chaer, Disciplina de Reumatologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil. fernandachaer@gmail.com

Provenance: submitted; externally peer reviewed.

Submitted: 22 April 2020; Peer review comments to author: 4 June 2020; Revised manuscript received: 8 June 2020; Accepted: 19 June 2020; Publication date: 28 July 2020.

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