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. 2025 Feb;28(2):e70145.
doi: 10.1111/1756-185X.70145.

Balancing Effective Treatments With Potential Threats: The Impact of Biologic Agent Use on Tuberculosis Development in Children With Chronic Inflammatory Disorders

Ayse Hitay Telefon  1 , Merve Kilic Cil  1 , Gulsum Sonmez  1 , Elif Afat Turgut  1 , Tugba Kandemir Gulmez  1 , Didem Gulcu Taskin  2 , Sevinc Garip  2 , Rabia Miray Kisla Ekinci  3 , Umit Celik  1
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Balancing Effective Treatments With Potential Threats: The Impact of Biologic Agent Use on Tuberculosis Development in Children With Chronic Inflammatory Disorders

Ayse Hitay Telefon et al. Int J Rheum Dis. 2025 Feb.

Abstract

Aim: We aimed to investigate the frequency and clinical characteristics of tuberculosis in pediatric patients receiving both anti-TNF-alpha and other biological agents.

Materials and methods: The data of 270 patients who used biological agents due to rheumatologic diseases and inflammatory bowel disease (IBD) and were followed between January 2021 and October 2023 were retrospectively collected from their files.

Results: Of the patients, 138(51.1%) were female, 132(48.9%) were male. The mean age at diagnosis was 107 months (min 8-max 215 months). Patients were most commonly followed for juvenile idiopathic arthritis (JIA) (191 patients, 70.7%), followed by other autoinflammatory diseases (49 patients) and IBD (26 patients, 9.6%). Treatments included adalimumab (97 patients, 35.9%), etanercept (85 patients, 31.5%), canakinumab (33 patients, 12.2%), tocilizumab (31 patients, 11.5%), infliximab (16 patients, 5.9%), anakinra (5 patients, 1.9%), tofacitinib (2 patients, 0.7%), and rituximab (1 patient, 0.4%). During follow-up, latent tuberculosis infection (LTBI) developed in 5 (1.9%) patients. Three of these patients had JIA (using adalimumab, etanercept and tocilizumab), one had Familial Mediterranean Fever (using canakinumab), and one had IBD (using adalimumab). The mean duration of biological agent treatment until LTBI development was 14.6 months (min 6-max 29 months). Tuberculosis disease was diagnosed in two patients. Both were patients followed up due to IBD. One of the patients was diagnosed with miliary tuberculosis after infliximab treatment, while the other was followed for tuberculosis lymphadenitis after adalimumab treatment. Quadruple anti-tuberculosis therapy was initiated for the patients.

Conclusion: The use of biological agents has revolutionized the course of chronic inflammatory diseases in childhood. However, in these patients, monitoring for tuberculosis risk is crucial.

Keywords: biologic agents; inflammatory bowel disease; pediatrics; rheumatology; tuberculosis.

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References

    1. S. Parigi, A. Licari, S. Manti, et al., “Tuberculosis and TNF‐α Inhibitors in Children: How to Manage a Fine Balance,” Acta Biomed 91, no. 11‐S (2020): e2020009, https://doi.org/10.23750/abm.v91i11‐S.10311.
    1. T. Lamireau, J. P. Cézard, A. Dabadie, et al., “Efficacy and Tolerance of Infliximab in Children and Adolescents With Crohn's Disease,” Inflammatory Bowel Diseases 10, no. 6 (2004): 745–750, https://doi.org/10.1097/00054725‐200411000‐00008.
    1. A. Noguera‐Julian, J. Calzada‐Hernández, F. Brinkmann, et al., “Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor‐ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (Ptbnet) Study,” Clinical Infectious Diseases 71, no. 10 (2020): 2561–2569, https://doi.org/10.1093/cid/ciz1138.
    1. S. S. Toussi, N. Pan, H. M. Walters, and T. J. Walsh, “Infections in Children and Adolescents With Juvenile Idiopathic Arthritis and Inflammatory Bowel Disease Treated With Tumor Necrosis Factor‐α Inhibitors: Systematic Review of the Literature,” Clinical Infectious Diseases 57, no. 9 (2013): 1318–1330, https://doi.org/10.1093/cid/cit489.
    1. M. S. Godfrey and L. N. Friedman, “Tuberculosis and Biologic Therapies: Anti‐Tumor Necrosis Factor‐α and Beyond,” Clinics in Chest Medicine 40, no. 4 (2019): 721–739, https://doi.org/10.1016/j.ccm.2019.07.003.

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