1887
No metrics data to plot.
The attempt to load metrics for this article has failed.
The attempt to plot a graph for these metrics has failed.

Biologic Agents and Tuberculosis

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.
  • HTML
    109.71 Kb
  • XML
    100.44 Kb
  • PDF
    278.38 Kb
  • Author: Claudia C. Dobler1,2
  • Editor: David Schlossberg3
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Liverpool Hospital and South Western Sydney Clinical School, University of New South Wales, New South Wales 2170, Australia; 2: Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales 2037, Australia; 3: Philadelphia Health Department, Philadelphia, PA
    • Source: microbiolspec December 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0026-2016
  • Received 30 October 2016 Accepted 07 November 2016 Published 23 December 2016
  • Claudia C. Dobler, [email protected]
image of Biologic Agents and Tuberculosis
    Preview this microbiology spectrum article:
    Preview Magnify
    Zoom in
    Zoomout

    Biologic Agents and Tuberculosis, Page 1 of 2

    | /docserver/preview/fulltext/microbiolspec/4/6/TNMI7-0026-2016-1.gif /docserver/preview/fulltext/microbiolspec/4/6/TNMI7-0026-2016-2.gif

  • Abstract:

    Treatment with biologic agents, in particular tumor necrosis factor alpha (TNF-α) inhibitors, is associated with an increased risk of tuberculosis (TB), and screening and treatment for latent TB infection (LTBI) in patients undergoing such treatment is therefore indicated. The risk of TB associated with different biologics varies significantly, with the highest relative risks, 29.3 and 18.6, associated with adalimumab and infliximab, respectively. The risk of TB with newer TNF-α inhibitors and other biologics appears to be lower. Performance of LTBI screening tests is affected by immune-mediated inflammatory diseases and immunosuppressive therapy in patients due to commence TNF-α inhibitor treatment. Interferon gamma release assays (IGRAs) have a higher specificity than the tuberculin skin test (TST) in patients with Bacillus Calmette–Guérin (BCG) vaccination and have probably a better sensitivity than TST in immunosuppressed patients. LTBI screening programs prior to commencement of anti-TNF-α treatment significantly reduce the incidence of TB, but the optimal screening algorithm, in particular the question of whether a combination of IGRA and TST or a single test only should be used, is a matter of ongoing debate. Use of TST in combination with IGRA is justified to increase sensitivity. Repeat testing for LTBI should be limited to patients at increased risk of TB. If TB develops during anti-TNF-α treatment, it is more likely to be disseminated and extrapulmonary than are other TB cases. Discontinuation of anti-TNF-α treatment in patients diagnosed with TB is associated with an increased risk of immune reconstitution inflammatory syndrome, which is probably best managed by reintroduction of anti-TNF-α treatment.

  • Citation: Dobler C. 2016. Biologic Agents and Tuberculosis. Microbiol Spectrum 4(6):TNMI7-0026-2016. doi:10.1128/microbiolspec.TNMI7-0026-2016.

References

1. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, Siegel JN, Braun MM. 2001. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 345:1098–1104. [PubMed]
2. Flynn JL, Goldstein MM, Chan J, Triebold KJ, Pfeffer K, Lowenstein CJ, Schreiber R, Mak TW, Bloom BR. 1995. Tumor necrosis factor-alpha is required in the protective immune response against Mycobacterium tuberculosis in mice. Immunity 2:561–572.
3. Tubach F, Salmon D, Ravaud P, Allanore Y, Goupille P, Bréban M, Pallot-Prades B, Pouplin S, Sacchi A, Chichemanian RM, Bretagne S, Emilie D, Lemann M, Lortholary O, Mariette X, Research Axed on Tolerance of Biotherapies Group. 2009. Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy: the three-year prospective French Research Axed on Tolerance of Biotherapies registry. Arthritis Rheum 60:1884–1894. [PubMed]
4. Zhou Q, Zhou Y, Chen H, Wang Z, Tang Z, Liu J. 2014. The efficacy and safety of certolizumab pegol (CZP) in the treatment of active rheumatoid arthritis (RA): a meta-analysis from nine randomized controlled trials. Int J Clin Exp Med 7:3870–3880. [PubMed]
5. Kay J, Fleischmann R, Keystone E, Hsia EC, Hsu B, Mack M, Goldstein N, Braun J, Kavanaugh A. 2015. Golimumab 3-year safety update: an analysis of pooled data from the long-term extensions of randomised, double-blind, placebo-controlled trials conducted in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. Ann Rheum Dis 74:538–546. [PubMed]
6. Salliot C, Dougados M, Gossec L. 2009. Risk of serious infections during rituximab, abatacept and anakinra treatments for rheumatoid arthritis: meta-analyses of randomised placebo-controlled trials. Ann Rheum Dis 68:25–32. [PubMed]
7. Campbell L, Chen C, Bhagat SS, Parker RA, Östör AJ. 2011. Risk of adverse events including serious infections in rheumatoid arthritis patients treated with tocilizumab: a systematic literature review and meta-analysis of randomized controlled trials. Rheumatology (Oxford) 50:552–562. [PubMed]
8. Colombel JF, Sands BE, Rutgeerts P, Sandborn W, Danese S, D’Haens G, Panaccione R, Loftus EV, Jr, Sankoh S, Fox I, Parikh A, Milch C, Abhyankar B, Feagan BG. 18 February 2016. The safety of vedolizumab for ulcerative colitis and Crohn’s disease. Gut doi:10.1136/gutjnl-2015-311079. [PubMed]
9. Tsai TF, Ho V, Song M, Szapary P, Kato T, Wasfi Y, Li S, Shen YK, Leonardi C, PHOENIX 1, PHOENIX 2, ACCEPT, PEARL and Japanese Ustekinumab Study Groups. 2012. The safety of ustekinumab treatment in patients with moderate-to-severe psoriasis and latent tuberculosis infection. Br J Dermatol 167:1145–1152. [PubMed]
10. Cantini F, Niccoli L, Nannini C, Cassarà E, Kaloudi O, Giulio Favalli E, Becciolini A, Biggioggero M, Benucci M, Li Gobbi F, Grossi V, Infantino M, Meacci F, Manfredi M, Guiducci S, Bellando-Randone S, Matucci-Cerinic M, Foti R, Di Gangi M, Mosca M, Tani C, Palmieri F, Goletti D, Italian board for the TAilored BIOlogic therapy (ITABIO). 2016. Tailored first-line biologic therapy in patients with rheumatoid arthritis, spondyloarthritis, and psoriatic arthritis. Semin Arthritis Rheum 45:519–532. [PubMed]
11. Dixon WG, Hyrich KL, Watson KD, Lunt M, Galloway J, Ustianowski A, Symmons DP, BSRBR Control Centre Consortium, BSR Biologics Register. 2010. 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 69:522–528. [PubMed]
12. Wallis RS, Broder MS, Wong JY, Hanson ME, Beenhouwer DO. 2004. Granulomatous infectious diseases associated with tumor necrosis factor antagonists. Clin Infect Dis 38:1261–1265. [PubMed]
13. Fallahi-Sichani M, Flynn JL, Linderman JJ, Kirschner DE. 2012. Differential risk of tuberculosis reactivation among anti-TNF therapies is due to drug binding kinetics and permeability. J Immunol 188:3169–3178. [PubMed]
14. Wallis RS, Broder M, Wong J, Beenhouwer D. 2004. Granulomatous infections due to tumor necrosis factor blockade: correction. Clin Infect Dis 39:1254–1255. [PubMed]
15. Gómez-Reino JJ, Carmona L, Valverde VR, Mola EM, Montero MD, BIOBADASER Group. 2003. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum 48:2122–2127. [PubMed]
16. Tubach F, Salmon-Céron D, Ravaud P, Mariette X, Group RS, RATIO Study Group. 2005. The RATIO observatory: French registry of opportunistic infections, severe bacterial infections, and lymphomas complicating anti-TnFalpha therapy. Joint Bone Spine 72:456–460. [PubMed]
17. Capogrosso Sansone A, Mantarro S, Tuccori M, Ruggiero E, Montagnani S, Convertino I, Marino A, Fornai M, Antonioli L, Corona T, Garibaldi D, Blandizzi C. 2015. Safety profile of certolizumab pegol in patients with immune-mediated inflammatory diseases: a systematic review and meta-analysis. Drug Saf 38:869–888. [PubMed]
18. Keyser FD. 2011. Choice of biologic therapy for patients with rheumatoid arthritis: the infection perspective. Curr Rheumatol Rev 7:77–87. [PubMed]
19. Lahiri M, Dixon WG. 2015. Risk of infection with biologic antirheumatic therapies in patients with rheumatoid arthritis. Best Pract Res Clin Rheumatol 29:290–305. [PubMed]
20. Atzeni F, Batticciotto A, Masala IF, Talotta R, Benucci M, Sarzi-Puttini P. 2016. Infections and biological therapy in patients with rheumatic diseases. Isr Med Assoc J 18:164–167. [PubMed]
21. Selmi C, Ceribelli A, Naguwa SM, Cantarini L, Shoenfeld Y. 2015. Safety issues and concerns of new immunomodulators in rheumatology. Expert Opin Drug Saf 14:389–399. [PubMed]
22. Cantini F, Niccoli L, Goletti D. 2014. Tuberculosis risk in patients treated with non-anti-tumor necrosis factor-α (TNF-α) targeted biologics and recently licensed TNF-α inhibitors: data from clinical trials and national registries. J Rheumatol Suppl 91:56–64. [PubMed]
23. Solovic I, Sester M, Gomez-Reino JJ, Rieder HL, Ehlers S, Milburn HJ, Kampmann B, Hellmich B, Groves R, Schreiber S, Wallis RS, Sotgiu G, Schölvinck EH, Goletti D, Zellweger JP, Diel R, Carmona L, Bartalesi F, Ravn P, Bossink A, Duarte R, Erkens C, Clark J, Migliori GB, Lange C. 2010. The risk of tuberculosis related to tumour necrosis factor antagonist therapies: a TBNET consensus statement. Eur Respir J 36:1185–1206. [PubMed]
24. Carmona L, Hernández-García C, Vadillo C, Pato E, Balsa A, González-Alvaro I, Belmonte MA, Tena X, Sanmartí R, EMECAR Study Group. 2003. Increased risk of tuberculosis in patients with rheumatoid arthritis. J Rheumatol 30:1436–1439. [PubMed]
25. Askling J, Fored CM, Brandt L, Baecklund E, Bertilsson L, Cöster L, Geborek P, Jacobsson LT, Lindblad S, Lysholm J, Rantapää-Dahlqvist S, Saxne T, Romanus V, Klareskog L, Feltelius N. 2005. Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum 52:1986–1992. [PubMed]
26. Seong SS, Choi CB, Woo JH, Bae KW, Joung CL, Uhm WS, Kim TH, Jun JB, Yoo DH, Lee JT, Bae SC. 2007. Incidence of tuberculosis in Korean patients with rheumatoid arthritis (RA): effects of RA itself and of tumor necrosis factor blockers. J Rheumatol 34:706–711. [PubMed]
27. Tikly M, Hodkinson B, Dheda K. 2015. Biologic therapy for rheumatoid arthritis in developing countries—a place for non-TNF inhibitors as first-line treatment? Rheumatology (Oxford) 54:208–209. [PubMed]
28. Hodkinson B, Van Duuren E, Pettipher C, Kalla A, South African Rheumatism and Arthritis Association. 2013. South African recommendations for the management of rheumatoid arthritis: an algorithm for the standard of care in 2013. S Afr Med J 103:576–585. [PubMed]
29. Ponce de Leon D, Acevedo-Vasquez E, Alvizuri S, Gutierrez C, Cucho M, Alfaro J, Perich R, Sanchez-Torres A, Pastor C, Sanchez-Schwartz C, Medina M, Gamboa R, Ugarte M. 2008. Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis (TB) infection in patients with rheumatoid arthritis in a TB-endemic population. J Rheumatol 35:776–781. [PubMed]
30. Casas S, Andreu A, Juanola X, Bordas X, Alcaide F, Moure R, Anibarro L, Cuchí E, Esteve M, Ortiz V, Guerra MR, Rodríguez J, Reina D, Salvador G, Guardiola J, Surís X, Pascual MA, Martí C, Martínez-Lacasa X, Cuquet J, Gonzalez L, Santin M. 2011. Diagnosis of tuberculosis infection by tuberculin skin test and a whole-blood interferon-γ release assay in patients considered for anti-tumor necrosis factor-α therapy. Diagn Microbiol Infect Dis 71:57–65. [PubMed]
31. Greenberg JD, Reddy SM, Schloss SG, Kurucz OS, Bartlett SJ, Abramson SB, Bingham CO, III. 2008. Comparison of an in vitro tuberculosis interferon-gamma assay with delayed-type hypersensitivity testing for detection of latent Mycobacterium tuberculosis: a pilot study in rheumatoid arthritis. J Rheumatol 35:770–775. [PubMed]
32. Schoepfer AM, Flogerzi B, Fallegger S, Schaffer T, Mueller S, Nicod L, Seibold F. 2008. Comparison of interferon-gamma release assay versus tuberculin skin test for tuberculosis screening in inflammatory bowel disease. Am J Gastroenterol 103:2799–2806. [PubMed]
33. Vassilopoulos D, Tsikrika S, Hatzara C, Podia V, Kandili A, Stamoulis N, Hadziyannis E. 2011. Comparison of two gamma interferon release assays and tuberculin skin testing for tuberculosis screening in a cohort of patients with rheumatic diseases starting anti-tumor necrosis factor therapy. Clin Vaccine Immunol 18:2102–2108. [PubMed]
34. Menzies D, Pai M, Comstock G. 2007. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 146:340–354. [PubMed]
35. Winthrop KL. 2010. The risk and prevention of tuberculosis: screening strategies to detect latent tuberculosis among rheumatoid arthritis patients who use biologic therapy. Int J Adv Rheumatol 8:43–52.
36. Hsia EC, Schluger N, Cush JJ, Chaisson RE, Matteson EL, Xu S, Beutler A, Doyle MK, Hsu B, Rahman MU. 2012. Interferon-γ release assay versus tuberculin skin test prior to treatment with golimumab, a human anti-tumor necrosis factor antibody, in patients with rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis. Arthritis Rheum 64:2068–2077. [PubMed]
37. Lalvani A, Millington KA. 2008. Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmun Rev 8:147–152. [PubMed]
38. Kleinert S, Tony HP, Krueger K, Detert J, Mielke F, Rockwitz K, Schwenke R, Burmester GR, Diel R, Feuchtenberger M, Kneitz C. 2012. Screening for latent tuberculosis infection: performance of tuberculin skin test and interferon-γ release assays under real-life conditions. Ann Rheum Dis 71:1791–1795. [PubMed]
39. Mariette X, Baron G, Tubach F, Lioté F, Combe B, Miceli-Richard C, Flipo RM, Goupille P, Allez M, Salmon D, Emilie D, Carcelain G, Ravaud P. 2012. Influence of replacing tuberculin skin test with ex vivo interferon γ release assays on decision to administer prophylactic antituberculosis antibiotics before anti-TNF therapy. Ann Rheum Dis 71:1783–1790. [PubMed]
40. Bartalesi F, Vicidomini S, Goletti D, Fiorelli C, Fiori G, Melchiorre D, Tortoli E, Mantella A, Benucci M, Girardi E, Cerinic MM, Bartoloni A. 2009. QuantiFERON-TB Gold and the TST are both useful for latent tuberculosis infection screening in autoimmune diseases. Eur Respir J 33:586–593. [PubMed]
41. Gogus F, Günendi Z, Karakus R, Erdogan Z, Hizel K, Atalay F. 2010. Comparison of tuberculin skin test and QuantiFERON-TB gold in tube test in patients with chronic inflammatory diseases living in a tuberculosis endemic population. Clin Exp Med 10:173–177. [PubMed]
42. Sauzullo I, Mengoni F, Scrivo R, Valesini G, Potenza C, Skroza N, Marocco R, Lichtner M, Vullo V, Mastroianni CM. 2010. Evaluation of QuantiFERON-TB Gold In-Tube in human immunodeficiency virus infection and in patient candidates for anti-tumour necrosis factor-alpha treatment. Int J Tuberc Lung Dis 14:834–840. [PubMed]
43. Ramos JM, Masiá M, Rodríguez JC, López C, Padilla S, Robledano C, Navarro-Blasco FJ, Matarredona J, García-Sepulcre MF, Gutiérrez F. 2013. Negative effect of immunosuppressive therapy in the performance of the QuantiFERON gold in-tube test in patients with immune-mediated inflammatory diseases. Clin Exp Med 13:177–186. [PubMed]
44. Laffitte E, Janssens JP, Roux-Lombard P, Thielen AM, Barde C, Marazza G, Panizzon RG, Saurat JH. 2009. Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: comparison of an interferon-gamma release assay vs. tuberculin skin test. Br J Dermatol 161:797–800. [PubMed]
45. Vassilopoulos D, Stamoulis N, Hadziyannis E, Archimandritis AJ. 2008. Usefulness of enzyme-linked immunospot assay (Elispot) compared to tuberculin skin testing for latent tuberculosis screening in rheumatic patients scheduled for anti-tumor necrosis factor treatment. J Rheumatol 35:1271–1276. [PubMed]
46. Martin J, Walsh C, Gibbs A, McDonnell T, Fearon U, Keane J, Codd MB, Dodd J, Veale D, Fitzgerald O, Bresnihan B. 2010. Comparison of interferon γ release assays and conventional screening tests before tumour necrosis factor α blockade in patients with inflammatory arthritis. Ann Rheum Dis 69:181–185. [PubMed]
47. Bocchino M, Matarese A, Bellofiore B, Giacomelli P, Santoro G, Balato N, Castiglione F, Scarpa R, Perna F, Signoriello G, Galati D, Ponticiello A, Sanduzzi A. 2008. Performance of two commercial blood IFN-gamma release assays for the detection of Mycobacterium tuberculosis infection in patient candidates for anti-TNF-alpha treatment. Eur J Clin Microbiol Infect Dis 27:907–913. [PubMed]
48. Shahidi N, Fu YT, Qian H, Bressler B. 2012. Performance of interferon-gamma release assays in patients with inflammatory bowel disease: a systematic review and meta-analysis. Inflamm Bowel Dis 18:2034–2042. [PubMed]
49. Bélard E, Semb S, Ruhwald M, Werlinrud AM, Soborg B, Jensen FK, Thomsen H, Brylov A, Hetland ML, Nordgaard-Lassen I, Ravn P. 2011. Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection. Inflamm Bowel Dis 17:2340–2349. [PubMed]
50. Taxonera C, Ponferrada A, Gisbert JP, Bermejo F, Martinez-Arranz MD, De Castro ML, Lopez-Serrano P, Vera MI, Garcia-Sanchez V, Hernandez-Camba A, Bastida G, Fernandez-Salazar L, Merino O, Gomez R, Ceballos D, Morales I, Alba C, Olivares D, Riestra S. 2015. Performance of tuberculin skin test in routine screening for latent tuberculosis infection in patients with inflammatory bowel diseases. J Crohns Colitis 9(Suppl 1) :S197–S198.
51. Redelman-Sidi G, Sepkowitz KA. 2013. IFN-γ release assays in the diagnosis of latent tuberculosis infection among immunocompromised adults. Am J Respir Crit Care Med 188:422–431. [PubMed]
52. Matulis G, Jüni P, Villiger PM, Gadola SD. 2008. Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases: performance of a Mycobacterium tuberculosis antigen-specific interferon gamma assay. Ann Rheum Dis 67:84–90. [PubMed]
53. Carmona L, Gómez-Reino JJ, Rodríguez-Valverde V, Montero D, Pascual-Gómez E, Mola EM, Carreño L, Figueroa M, BIOBADASER Group. 2005. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum 52:1766–1772. [PubMed]
54. Centers for Disease Control and Prevention. 2004. Tuberculosis associated with blocking agents against tumor necrosis factor-alpha—California, 2002-2003. MMWR Morb Mortal Wkly Rep 53:683–686. [PubMed]
55. Mazurek GH, Jereb J, Vernon A, LoBue P, Goldberg S, Castro K, IGRA Expert Committee, Centers for Disease Control and Prevention. 2010. Updated guidelines for using interferon gamma release assays to detect Mycobacterium tuberculosis infection—United States, 2010. MMWR Recommend Rep 59(RR-5) :1–25. [PubMed]
56. Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, Moreland LW, O’Dell J, Winthrop KL, Beukelman T, Bridges SL, Jr, Chatham WW, Paulus HE, Suarez-Almazor M, Bombardier C, Dougados M, Khanna D, King CM, Leong AL, Matteson EL, Schousboe JT, Moynihan E, Kolba KS, Jain A, Volkmann ER, Agrawal H, Bae S, Mudano AS, Patkar NM, Saag KG. 2012. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken) 64:625–639. [PubMed]
57. Canadian Thoracic Society. 2013. Treatment of latent tuberculosis infection, p 44A-53A. In Canadian tuberculosis standards, 7th ed. Canadian Thoracic Society and The Public Health Agency of Canada. http://www.respiratoryguidelines.ca/sites/all/files/Canadian_TB_Standards_7th_Edition_ENG.pdf
58. Ledingham J, Wilkinson C, Deighton C. 2005. British Thoracic Society (BTS) recommendations for assessing risk and managing tuberculosis in patients due to start anti-TNF-alpha treatments. Rheumatology (Oxford) 44:1205–1206. [PubMed]
59. Mariette X, Salmon D. 2003. French guidelines for diagnosis and treating latent and active tuberculosis in patients with RA treated with TNF blockers. Ann Rheum Dis 62:791. [PubMed]
60. Salmon D, Groupe Tuberculose et infliximab, Agence Française de Sécurité Sanitaire de Produits de Santé. 2002. Recommendations about the prevention and management of tuberculosis in patients taking infliximab. Joint Bone Spine 69:170–172.
61. Beglinger C, Dudler J, Mottet C, Nicod L, Seibold F, Villiger PM, Zellweger JP. 2007. Screening for tuberculosis infection before the initiation of an anti-TNF-alpha therapy. Swiss Med Wkly 137:620–622. [PubMed]
62. Muñoz L, Casas S, Juanola X, Bordas X, Martinez C, Santin M, Prevention of Anti-TNF-Associated Tuberculosis Study Team of Bellvitge University Hospital. 2015. Prevention of anti-tumor necrosis factor-associated tuberculosis: a 10-year longitudinal cohort study. Clin Infect Dis 60:349–356. [PubMed]
63. Jung YJ, Lee JY, Jo KW, Yoo B, Lee CK, Kim YG, Yang SK, Byeon JS, Kim KJ, Ye BD, Lee KH, Lee SD, Kim WS, Kim DS, Shim TS. 2014. The ‘either test positive’ strategy for latent tuberculous infection before anti-tumour necrosis factor treatment. Int J Tuberc Lung Dis 18:428–434. [PubMed]
64. British Thoracic Society Standards of Care Committee. 2005. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. Thorax 60:800–805. [PubMed]
65. Singanayagam A, Manalan K, Sridhar S, Molyneaux PL, Connell DW, George PM, Kindelerer A, Seneviratne S, Lalvani A, Wickremasinghe M, Kon OM. 2013. Evaluation of screening methods for identification of patients with chronic rheumatological disease requiring tuberculosis chemoprophylaxis prior to commencement of TNF-α antagonist therapy. Thorax 68:955–961. [PubMed]
66. Hewitt RJ, Singanayagam A, Sridhar S, Wickremasinghe M, Min Kon O. 2015. Screening for latent tuberculosis before tumour necrosis factor antagonist therapy. Eur Respir J 45:1510–1512. [PubMed]
67. Winthrop KL, Weinblatt ME, Daley CL. 2012. You can’t always get what you want, but if you try sometimes (with two tests—TST and IGRA—for tuberculosis) you get what you need. Ann Rheum Dis 71:1757–1760. [PubMed]
68. Liao TL, Lin CH, Chen YM, Chang CL, Chen HH, Chen DY. 2016. Different risk of tuberculosis and efficacy of isoniazid prophylaxis in rheumatoid arthritis patients with biologic therapy: a nationwide retrospective cohort study in Taiwan. PLoS One 11:e0153217. [PubMed]
69. Park SJ, Jo KW, Yoo B, Lee CK, Kim YG, Yang SK, Byeon JS, Kim KJ, Ye BD, Park SH, Shim TS. 2015. Comparison of LTBI treatment regimens for patients receiving anti-tumour necrosis factor therapy. Int J Tuberc Lung Dis 19:342–348. [PubMed]
70. Doherty SD, Van Voorhees A, Lebwohl MG, Korman NJ, Young MS, Hsu S, National Psoriasis Foundation. 2008. National Psoriasis Foundation consensus statement on screening for latent tuberculosis infection in patients with psoriasis treated with systemic and biologic agents. J Am Acad Dermatol 59:209–217. [PubMed]
71. O’Shea MK, Fletcher TE, Beeching NJ, Dedicoat M, Spence D, McShane H, Cunningham AF, Wilson D. 2014. Tuberculin skin testing and treatment modulates interferon-gamma release assay results for latent tuberculosis in migrants. PLoS One 9:e97366. [PubMed]
72. Pollock NR, Kashino SS, Napolitano DR, Sloutsky A, Joshi S, Guillet J, Wong M, Nardell E, Campos-Neto A. 2009. Evaluation of the effect of treatment of latent tuberculosis infection on QuantiFERON-TB gold assay results. Infect Control Hosp Epidemiol 30:392–395. [PubMed]
73. Hatzara C, Hadziyannis E, Kandili A, Koutsianas C, Makris A, Georgiopoulos G, Vassilopoulos D. 2015. Frequent conversion of tuberculosis screening tests during anti-tumour necrosis factor therapy in patients with rheumatic diseases. Ann Rheum Dis 74:1848–1853. [PubMed]
74. Slater ML, Welland G, Pai M, Parsonnet J, Banaei N. 2013. Challenges with QuantiFERON-TB Gold assay for large-scale, routine screening of U.S. healthcare workers. Am J Respir Crit Care Med 188:1005–1010. [PubMed]
75. Metcalfe JZ, Cattamanchi A, McCulloch CE, Lew JD, Ha NP, Graviss EA. 2013. Test variability of the QuantiFERON-TB gold in-tube assay in clinical practice. Am J Respir Crit Care Med 187:206–211. [PubMed]
76. Scrivo R, Sauzullo I, Mengoni F, Priori R, Coppola M, Iaiani G, DI Franco M, Vullo V, Mastroianni CM, Valesini G. 2013. Mycobacterial interferon-γ release variations during longterm treatment with tumor necrosis factor blockers: lack of correlation with clinical outcome. J Rheumatol 40:157–165. [PubMed]
77. Hofland RW, Thijsen SF, Verhagen MA, Schenk Y, Bossink AW. 2013. Tuberculosis during TNF-α inhibitor therapy, despite screening. Thorax 68:1079–1080. [PubMed]
78. Mohan AK, Coté TR, Block JA, Manadan AM, Siegel JN, Braun MM. 2004. Tuberculosis following the use of etanercept, a tumor necrosis factor inhibitor. Clin Infect Dis 39:295–299. [PubMed]
79. Kwon YS, Kim YH, Jeon K, Jeong BH, Ryu YJ, Choi JC, Kim HC, Koh WJ. 2015. Factors that predict negative results of QuantiFERON-TB Gold In-Tube test in patients with culture-confirmed tuberculosis: a multicenter retrospective cohort study. PLoS One 10:e0129792. [PubMed]
80. Suh S, Bae H, Kondapaneni S, Jathavedam A, Tzeng J, Bryan C, Lee Y. 2015. A patient with negative Quantiferon-TB gold test developed tuberculosis pleurisy after adalimumab therapy. Am J Respir Crit Care Med 191:A3258.
81. Sichletidis L, Settas L, Spyratos D, Chloros D, Patakas D. 2006. Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis. Int J Tuberc Lung Dis 10:1127–1132. [PubMed]
82. Ozguler Y, Hatemi G, Ugurlu S, Seyahi E, Melikoglu M, Borekci S, Atahan E, Ongen G, Hamuryudan V. 2016. Re-initiation of biologics after the development of tuberculosis under anti-TNF therapy. Rheumatol Int 36:1719–1725. [PubMed]
83. Abreu C, Sarmento A, Magro F. 2016. Reintroduction of anti-TNFα therapy after (or even during) anti-TNFα-associated tuberculosis in immune-mediated diseases. J Crohns Colitis 10:120–121. [PubMed]
84. Garcia Vidal C, Rodríguez Fernández S, Martínez Lacasa J, Salavert M, Vidal R, Rodríguez Carballeira M, Garau J. 2005. Paradoxical response to antituberculous therapy in infliximab-treated patients with disseminated tuberculosis. Clin Infect Dis 40:756–759. [PubMed]
85. Belknap R, Reves R, Burman W. 2005. Immune reconstitution to Mycobacterium tuberculosis after discontinuing infliximab. Int J Tuberc Lung Dis 9:1057–1058. [PubMed]
86. Wallis RS, van Vuuren C, Potgieter S. 2009. Adalimumab treatment of life-threatening tuberculosis. Clin Infect Dis 48:1429–1432. [PubMed]
87. Rivoisy C, Tubach F, Roy C, Nicolas N, Mariette X, Salmon D, Lortholary O, Bourgarit A, Bagheri H, Blandin B, Breban M, Bretagne S, Castot A, Chichmanian RM, Chosidow O, Dautzenberg B, Dellamonica P, Dufeu-Demazes N, Emilie D, Gillet C, Hugot JP, Kreft-Jais C, Lemann M, Leport C, Michelet C, Montastruc JL, Prieur AM, Ravaud P, Roux C, Vittecoq D, RATIO Group. 2016. Paradoxical anti-TNF-associated TB worsening: frequency and factors associated with IRIS. Joint Bone Spine 83:173–178. [PubMed]
88. Meintjes G, Wilkinson RJ, Morroni C, Pepper DJ, Rebe K, Rangaka MX, Oni T, Maartens G. 2010. Randomized placebo-controlled trial of prednisone for paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome. AIDS 24:2381–2390.
89. Blackmore TK, Manning L, Taylor WJ, Wallis RS. 2008. Therapeutic use of infliximab in tuberculosis to control severe paradoxical reaction of the brain and lymph nodes. Clin Infect Dis 47:e83–e85. [PubMed]
Loading

Article metrics loading...

/content/journal/microbiolspec/10.1128/microbiolspec.TNMI7-0026-2016
2016-12-23
2020-07-14

Abstract:

Treatment with biologic agents, in particular tumor necrosis factor alpha (TNF-α) inhibitors, is associated with an increased risk of tuberculosis (TB), and screening and treatment for latent TB infection (LTBI) in patients undergoing such treatment is therefore indicated. The risk of TB associated with different biologics varies significantly, with the highest relative risks, 29.3 and 18.6, associated with adalimumab and infliximab, respectively. The risk of TB with newer TNF-α inhibitors and other biologics appears to be lower. Performance of LTBI screening tests is affected by immune-mediated inflammatory diseases and immunosuppressive therapy in patients due to commence TNF-α inhibitor treatment. Interferon gamma release assays (IGRAs) have a higher specificity than the tuberculin skin test (TST) in patients with Bacillus Calmette–Guérin (BCG) vaccination and have probably a better sensitivity than TST in immunosuppressed patients. LTBI screening programs prior to commencement of anti-TNF-α treatment significantly reduce the incidence of TB, but the optimal screening algorithm, in particular the question of whether a combination of IGRA and TST or a single test only should be used, is a matter of ongoing debate. Use of TST in combination with IGRA is justified to increase sensitivity. Repeat testing for LTBI should be limited to patients at increased risk of TB. If TB develops during anti-TNF-α treatment, it is more likely to be disseminated and extrapulmonary than are other TB cases. Discontinuation of anti-TNF-α treatment in patients diagnosed with TB is associated with an increased risk of immune reconstitution inflammatory syndrome, which is probably best managed by reintroduction of anti-TNF-α treatment.

Highlighted Text: Show | Hide
Loading full text...

Full text loading...

/deliver/fulltext/microbiolspec/4/6/TNMI7-0026-2016.html?itemId=/content/journal/microbiolspec/10.1128/microbiolspec.TNMI7-0026-2016&mimeType=html&fmt=ahah

Tables

Biologic Agents and Tuberculosis
[com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/author/microbiolspec/10.1128/microbiolspec.TNMI7-0026-2016-1,webId=/content/author/microbiolspec/10.1128/microbiolspec.TNMI7-0026-2016-1,properties={foaf_givenname=Claudia C., foaf_name=Claudia C. Dobler, foaf_surname=Dobler, pub_isAffiliatedWith=[com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/affiliation/microbiolspec/10.1128/microbiolspec.TNMI7-0026-2016-aff2],com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/affiliation/microbiolspec/10.1128/microbiolspec.TNMI7-0026-2016-aff1]]}]]
Citation: Dobler C. 2016. Biologic agents and tuberculosis. microbiolspec 4(6): doi:10.1128/microbiolspec.TNMI7-0026-2016
/content/microbiolspec/10.1128/microbiolspec.TNMI7-0026-2016.T1
TABLE 1
Drug-specific RR of TB
Generic image for table

Click to view

TABLE 1

Drug-specific RR of TB

Source: microbiolspec December 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0026-2016
/content/microbiolspec/10.1128/microbiolspec.TNMI7-0026-2016.T2
TABLE 2
Recommendations for LTBI screening and treatment in different countries
Generic image for table

Click to view

TABLE 2

Recommendations for LTBI screening and treatment in different countries

Source: microbiolspec December 2016 vol. 4 no. 6 doi:10.1128/microbiolspec.TNMI7-0026-2016

Supplemental Material

No supplementary material available for this content.

Back to top
This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error