CC BY
7mediterranean journal 26
of RHEUMATOLOGY 1
EAAHNIKH PEYMATQAOriA 2015
Zuxvn 0£TiKonoir|or| tuv óoKipaoiúv eXéYxou (mantoux, igras) Yia QuMaTÍuon oe aoBeveÍQ nou unoß6ÄAovTai oe anti-TNF aYUYH
X. XaTZápa, MD, E. XaTZnYiávvri, MD, A. KavSúXn, MD, X. KouToiaváq, MD, A. MaKpn, MD, r. rewpYiónouXoq, MD, A. BaoiXónouXoq, MD,PhD
Movaöa KAlvlkhq AvoooXc>YÍaq-Peu|jaToXoYÍaq, B' naBoXoYiKr] KXiviKr] Kai Opwvupo EpYaorHipio, larpiKr) ZxoXn EKnA, InnoKpáTeio rNA, ABHva
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EiaaywYn: Oi óüKipaoíeQ eXéYxou Yia XoÍMuEin anó to MuKoßaKrnpiöio TnQ QuMaTÍuonQ (Mantoux, IGRAs) éxouv KaBiepuBeÍ ötov éXeYxo npó évap^nQ aYUYHQ Me anti-TNF napáYovieQ. O póXoQ tüuq oTnv TaKTiKn napaKoXoúBnon tuv aoBevúv KaTá Tn SiápKeia TnQ aYUYHQ napaMévei áYvuoTOQ ZKonÓQ thq MeAérnQ: Na MeXeTnBeÍ n ouxvÓTnTa eM0ávionQ BeTiKÚv SoKiMaoiúv Yia 0uMaTÍuon KaTá Tn SiápKeia aYWYHQ Me anti-TNF napáYovTeQ oe aoBeveÍQ Me apvnTiKÓ npoBepaneuTiKÓ éXeYxo.
YAikó Kai M¿0o6oq: MeXeTnBnKav 70 aoBeveÍQ (PA n=33, onovöuXoapBpniöeQ n=33, áXXeQ naBnoeiQ n=4) Me apvnTiKÓ éXeYxo npiv Tnv évap^n anti-TNF aYUYHQ [Mantoux < 5 mm, IGRAs: T.Spot®-TB Kai QuantiFERON®-TB Gold In Tube/QFT-GIT (-)]. Eva éTOQ MeTá Tnv évap^n anti-TNF (adalimumab n=27, etanercept n=14, infliximab n=16, golimumab n=8, certolizumab pegol n=5) óXoi oi aoBeveÍQ unoßXHBnKav oe enavéXeYxo (Mantoux, IGRAs).
AnoTeAeapaTa: Ze 20 aoBeveÍQ (29%) 9eTiKonoin9nKe MÍa TouXáxioTov SoKiMaoÍa: 9 aoBeveÍQ (13%) eM0ávioav BeTiKonoÍnon TnQ Mantoux (> 5 mm), 7 (10%) tou T.Spot®-TB Kai 5 (7%) TnQ QFT-GIT. 'EvaQ aoBevñQ BeTiKonoÍnoe >1 SoKiMaoÍeQ evú évaQ aoBevñQ Me SianioTUMévn éKBeon oe M.Tb KaTá Tn SiápKeia TnQ aYUYHQ, BeTiKonoÍnoe to T.Spot®-TB. Ze noXunapaYovTiaKn aváXuon, Móvo n Xn^n Infliximab ouoxeTÍoBnKe Me MeiUMévn ouxvóTnTa BeTiKonoÍnonQ KánoiaQ SoKiMaoÍaQ
(p=0.017). EvepYóQ TB öev avanTÚxBnKe oe Kavévav anó touq aoBeveÍQ (40% éXaßav aYUYH Me iooviaZÍSn) KaTá touq 27 ± 12 MñveQ TnQ napaKoXoúBnonQ. ZuMnepáapaTa: nepÍnou 1/3 tuv aoBevúv Me apvnTiKó npoBepaneuTiKó éXeYxo Yia TB BeTiKonoÍnoe MÍa TouXáxiorov SoKiMaoÍa Yia TB KaTá Tn SiápKeia TnQ BepaneÍaQ. Ta eupnMaTa auTá npénei va a^ioXoYnBoúv Yia to oxeSiaoMó TnQ KaTáXXnXnQ orpa^Y^HQ napaKoXoúBnonQ aoBevúv Yia TB unó anti-TNF aYUYH.
Mediterr J Rheumatol 2015; 26(1): 72-73
Ynsu8uvoq AXXr|Xoypa0iaq;
AvanA. Kae. A. BAZIAOnOYAOZ
MoväSa KAiviKiiQ AvoaoAoyiaQ-PeuiJaToAoYiaq
B' naeoAoYiKn KAiviKii Kai 0|_iwvu|_io EpYaaTiipio
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E-mail: [email protected] Corresponding author;
Associate Professor D. Vassilopoulos
Clinical Immunology and Rheumatology Unit
2nd Department of Internal Medicine and Laboratory
EKPA Medical School
Hipokration General Hospital
Athens
E-mail: [email protected]
Aé^eiQ-KXeiSiá: Anti-TNF, IGRAs, OuMCuluon
AnOMYEAINQIH KAIAAAEXNEYROAORIKEX ANEniQYMHTEI ENEREEIEI META AnO ANTI-TNF-A QERAnEIA DEMYELiNATiON AND OTHER NEUROLOGiCAL SiDE EFFECTS AFTER ANTi-TNF-A TREATMENT
Frequent conversion of screening tests for tuberculosis (Mantoux, IGRAs) in patients on anti-TNF treatment
C. Chatzara, MD, E. Chadjiyanni, MD, A. Kandyli, MD, C. Koutsianas, MD, A. Makri, MD, G. Georgiopoulos, MD, D. Vassilopoulos, MD, PhD
Clinical Immunology and Rheumatology Unit, 2nd Department of Internal Medicine and Laboratory, EKPA Medical School, Hipokration General Hospital, Athens
ABSTRACT
Objective. Sceening test for tuberculosis (Mantoux, IGRAs) are established tests before the initiation of anti-TNF treatment. Their role in the follow up of patients remains unknown. The aim of the study was to investigate the frequency of positive screening tests for tuberculosis during treatment with anti-TNF agents in patients with negative tests
Materials and methods. We studied 70 patients (RA, n=33, spondyloartritides, n=33, other diseases, n=4) with negative screening tests before the initiation of anti-TNF treatment (Mantoux < 5mm, IGRAs: IGRAs: T.Spot®-TB and QuantiFERON®-TB Gold In Tube/QFT-GIT (-)]. One year after the initiation of anti-TNF (adalimumab n=27, etanercept n=14, infliximab n=16, golimumab n=8, certolizumab pegol n=5) all patients underwent in re-screening (Mantoux, IGRAs). Results. In 20 patients (29%) there was a conversion of at least one test: 9 patients (13%) had positive Mantoux (> 5 mm), 7 (10%) positive T.Spot®-TB and 5 (7%) had positive QFT-GIT. One patient was positive for >1 tests, while one patient with confirmed exposure to M.Tb during treatment had positive T.Spot®-TB. In multivariable analysis, only Infliximab correlated with decreased frequency of positivity of a test (p=0.017). Active TB was not detected in any patient (40% of patients received isoniazid) during 27 ± 12 months of follow up. Conclusion. Approximately 1/3 of patients with negative pro-treatment screeing test for TB had at least a positive TB test during treatment. These findings should be evaluated for the appropriate strategy of follow up of patients under anti-TNF treatment.
Mediterr J Rheumatol 2015; 26(1): 72-73
Keywords: Anti-TNF, IGRAs, Tuberculosis
