FOLLOW UP RESULTS OF LATENT TUBERCULOSIS INFECTION IN PATIENTS TREATED WITH ANTI-TNF-ALPHA

Objective: This study was planned to evaluate our approach to latent tuberculosis infection in patients who are given anti-tumornecrosis factor-alpha (TNF-alpha) therapy. Material and Method: Observation results of 196 patients who were given anti-TNF-alpha therapy and between August 2005 and March 2010 were evaluated. Results: Of the patients, 100 were men and 96 were women. Mean age was 38.87 +/- 16.18. The tuberculin skin tests were evaluated on an average 10.75 +/- 6.82 mm. 17 patients (8.6%) there was no BCG scar, the rest had at least one BCG scar Infliximab was given to 98 of the patients (50%), etanercept was given to 66 of the patients (33.7%) and adalimumab was given to 32 of the patients (16.3%). By screening chest x-ray, tuberculin skin tests and histories, latent tuberculosis was found in 161 patients (82.1%) and prophylactic therapy with isoniaside were given for nine months. During the study period only one patient (0.5%) progressed to pleural tuberculosis. Liver function tests increased in 28 of the 161 patients who had been given prophylactic therapy (17.3 %), and prophylactic therapy was interrupted in 8 patients due to progressive hepatotoxicity. The rate of latent tuberculosis infection treatment interruption due to hepatotoxicity was noted as 4.9 % of all treated patients and as 28.5% of patients who had developed hepatotoxicity.. The mean age of the patients who had progressive hepatotoxicity (45.03+14.15) was higher than the patients who did not have progressive hepatotoxicity (40.30 +/- 14.69). Conclusion: As a result, isoniaside prophylactic therapy in the patients whose tuberculin skin tests were higher than 5 mm and above indurations was effective to protect them from developing active tuberculosis. We think that the risk of hepatotoxicity was acceptable and tuberculin skin test was reliable for determining latent tuberculosis infection.