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PLoS One. 2016 Apr 21;11(4):e0153816. doi: 10.1371/journal.pone.0153816. eCollection 2016.

Safety of Resuming Tumor Necrosis Factor Inhibitors in Ankylosing Spondylitis Patients Concomitant with the Treatment of Active Tuberculosis: A Retrospective Nationwide Registry of the Korean Society of Spondyloarthritis Research.

Author information

1
Department of Internal Medicine, Yonsei University College of Medicine, Division of Rheumatology, Gangnam Severance Hospital, Seoul, Korea.
2
Division of Rheumatology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
3
Division of Rheumatology, Department of Internal Medicine, Arthritis and Autoimmunity Research Center, Catholic University of Daegu School of Medicine, Daegu, Korea.
4
Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea.
5
Division of Rheumatology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
6
Division of Rheumatology, Department of Internal Medicine, Ajou University Hospital, Suwon, Korea.
7
Division of Rheumatology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
8
Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea.
9
Department of Rheumatology, Center of Arthritis and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
10
Division of Rheumatology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.
11
Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Medical center, Seoul, Korea.
12
Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
13
Division of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
14
Division of Rheumatology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Abstract

BACKGROUNDS:

Patients who develop an active tuberculosis infection during tumor necrosis factor (TNF) inhibitor treatment typically discontinue TNF inhibitor and receive standard anti-tuberculosis treatment. However, there is currently insufficient information on patient outcomes following resumption of TNF inhibitor treatment during ongoing anti- tuberculosis treatment. Our study was designed to investigate the safety of resuming TNF inhibitors in ankylosing spondylitis (AS) patients who developed tuberculosis as a complication of the use of TNF inhibitors.

METHODS:

Through the nationwide registry of the Korean Society of Spondyloarthritis Research, 3929 AS patients who were prescribed TNF inhibitors were recruited between June 2003 and June 2014 at fourteen referral hospitals. Clinical information was analyzed about the patients who experienced tuberculosis after exposure to TNF inhibitors. The clinical features of resumers and non-resumers of TNF inhibitors were compared and the outcomes of tuberculosis were surveyed individually.

FINDINGS:

Fifty-six AS patients were treated for tuberculosis associated with TNF inhibitors. Among them, 23 patients resumed TNF inhibitors, and these patients were found to be exposed to TNF inhibitors for a longer period of time and experienced more frequent disease flare-up after discontinuation of TNF inhibitors compared with those who did not resume. Fifteen patients resumed TNF inhibitors during anti-tuberculosis treatment (early resumers) and 8 after completion of anti-tuberculosis treatment (late resumers). Median time to resuming TNF inhibitor from tuberculosis was 3.3 and 9.0 months in the early and late resumers, respectively. Tuberculosis was treated successfully in all resumers and did not relapse in any of them during follow-up (median 33.8 [IQR; 20.8-66.7] months).

CONCLUSIONS:

Instances of tuberculosis were treated successfully in our AS patients, even when given concomitantly with TNF inhibitors. We suggest that early resumption of TNF inhibitors in AS patients could be safe under effective coverage of tuberculosis.

PMID:
27101309
PMCID:
PMC4839632
DOI:
10.1371/journal.pone.0153816
[Indexed for MEDLINE]
Free PMC Article

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