Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 15;36(10):e70.
doi: 10.3346/jkms.2021.36.e70.

Risk of Tuberculosis Development in Patients with Rheumatoid Arthritis Receiving Targeted Therapy: a Prospective Single Center Cohort Study

Yeo Jin Song  1 , Soo Kyung Cho  1 , Hyoungyoung Kim  1 , Hye Won Kim  1 , Eunwoo Nam  1 , Sang Cheol Bae  1 , Dae Hyun Yoo  1 , Yoon Kyoung Sung  2
Affiliations

Risk of Tuberculosis Development in Patients with Rheumatoid Arthritis Receiving Targeted Therapy: a Prospective Single Center Cohort Study

Yeo Jin Song et al. J Korean Med Sci. .

Abstract

Background: Patients with rheumatoid arthritis (RA) undergoing targeted therapy have a higher risk of developing tuberculosis (TB). This requires diagnosis and treatment of latent tuberculosis infection (LTBI). We aimed to evaluate whether diagnosis and treatment of LTBI in RA are effective in Korea, and to estimate the risk of TB development by calculating the incidence rate of active TB among RA patients receiving targeted therapy.

Methods: We analyzed data from two prospective cohort studies of RA patients who received biologic disease-modifying antirheumatic drugs (bDMARDs) or Janus kinase (JAK) inhibitor. We selected new starters of targeted therapy and classified them into three groups receiving tumor necrosis factor (TNF) inhibitor, non-TNF inhibitor, and JAK inhibitor, respectively. We then compared LTBI prevalence, treatments, and active TB incidence during first-line therapy in each group.

Results: A total of 765 RA patients (574 TNF inhibitor users, 132 non-TNF inhibitor users, and 59 JAK inhibitor users) were included in this study. Observation periods were 1,255.2 person-years (PYs), 264.7 PYs, and 53.3 PYs, respectively. All 765 patients underwent LTBI screening, and the positivity rate was 26.5% (n = 203). Of the 203 LTBI-positive patients, 189 (93.1%) received treatment. Only one patient, who was in the TNF inhibitor group, and was negative for the interferon gamma release assay (IGRA), did not receive LTBI treatment and developed active TB during follow-up.

Conclusion: Although the prevalence of LTBI in RA patients who started targeted therapy was slightly elevated, the Korean guidelines specifying LTBI screening and treatment were effective in preventing latent TB from becoming active.

Keywords: Biologic Disease-Modifying Antirheumatic Drugs; Janus Kinase Inhibitor; Latent Tuberculosis Infection; Rheumatoid Arthritis.

PubMed Disclaimer

Conflict of interest statement

DHY received research grants from Celltrion and HR, and is on the speakers bureau of Celltrion and Celltrion Healthcare. YKS received research grants from Bristol-Myers Squibb, Eisai, Pfizer, and JW Pharmaceutical. YJS, SKC, HK, HWK, EN, and SCB have no disclosures to declare. All authors declare no conflict of interest associated with this work.

Figures

Fig. 1
Fig. 1. Flow diagram of patient selection.
RA = rheumatoid arthritis, bDMARDs = biologic disease-modifying antirheumatic drugs, TNF = tumor necrosis factor, JAK = Janus kinase.
See this image and copyright information in PMC

References

    1. Doran MF, Crowson CS, Pond GR, O'Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum. 2002;46(9):2287–2293. - PubMed
    1. Shim TS. Diagnosis and treatment of latent tuberculosis infection due to initiation of anti-tnf therapy. Tuberc Respir Dis (Seoul) 2014;76(6):261–268. - PMC - PubMed
    1. Jeon D. Latent tuberculosis infection: recent progress and challenges in South Korea. Korean J Intern Med. 2020;35(2):269–275. - PMC - PubMed
    1. Iannone F, Cantini F, Lapadula G. Diagnosis of latent tuberculosis and prevention of reactivation in rheumatic patients receiving biologic therapy: international recommendations. J Rheumatol Suppl. 2014;91(0):41–46. - PubMed
    1. Ponce de León D, Acevedo-Vásquez E, Sánchez-Torres A, Cucho M, Alfaro J, Perich R, et al. Attenuated response to purified protein derivative in patients with rheumatoid arthritis: study in a population with a high prevalence of tuberculosis. Ann Rheum Dis. 2005;64(9):1360–1361. - PMC - PubMed

MeSH terms

Substances