Latent and active tuberculosis development in patients with rheumatoid arthritis receiving biologic disease-modifying antirheumatic drugs: A single-center prospective study

• Published in: PloS one Vol. 19; no. 1; p. e0295048
• Main Authors: Hai, Binh Bui, Anh, Tuan Le, Thi Thu, Phuong Nguyen, Van, Hung Nguyen, Van, Giap Vu, Van, Dung Hoang
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11.01.2024; Public Library of Science (PLoS)
• Subjects: Antiarthritic agents; Antirheumatic Agents - adverse effects; Arthritis; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - epidemiology; Autoimmune diseases; B cells; Biochemistry; Biological Factors - therapeutic use; Biological products; Biological Products - adverse effects; Biology and Life Sciences; Bronchoscopy; Chi-square test; Clinical medicine; Clinical trials; Complications and side effects; Computed tomography; Data collection; Development and progression; Diagnosis; Drug development; Drug dosages; Drug therapy; Drugs; Health aspects; Health services; Humans; Hypertension; Immunoassay; Infections; Interferon; Kinases; Latent Tuberculosis - diagnosis; Latent Tuberculosis - drug therapy; Latent Tuberculosis - epidemiology; Medical diagnosis; Medical research; Medicine and Health Sciences; Medicine, Experimental; Monoclonal antibodies; Patients; Prospective Studies; Research and Analysis Methods; Rheumatoid arthritis; Rheumatoid factor; Rheumatology; Risk factors; Software; Sputum; Tomography; Tuberculosis; Tuberculosis - complications; Tuberculosis - diagnosis; Tuberculosis - epidemiology; Tumor Necrosis Factor-alpha - therapeutic use; Tumor necrosis factor-TNF; Variance analysis; Vietnam; United Kingdom
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0295048

Biologics have revolutionized the treatment of rheumatoid arthritis (RA) in recent years. However, data from clinical trials and actual clinical practice have shown that biologics currently in use may constitute a risk factor for reactivation of tuberculosis (TB) in patients with latent TB infection. Therefore, screening for latent and active TB infection is mandatory before initiating biologic therapy in patients with RA. This prospective study aimed to analyze the clinical characteristics of patients with RA receiving biologic disease-modifying antirheumatic drugs at Bach Mai Hospital, Vietnam, between 2017 and 2022, and to identify factors affecting the occurrence of active and latent TB infection among these patients. Over a 12-month follow-up period, latent TB infection was confirmed in 20% of the total 180 included patients, while 3 (1.7%) patients developed active TB (one case of pulmonary, pleural, and gluteal TB each). History of TB risk factor exposure and lack of education were significantly associated with the occurrence of active and latent TB infection, with odds ratios (95% confidence intervals [CIs]) of 1.98 (1.78; 2.2) and 1.45 (1.31; 1.6), respectively. Follow-up duration and number of X-ray, computed tomography, bronchoscopy, and sputum acid-fast bacteria examinations were identified as factors that can aid in the early diagnosis of latent TB, with odds ratios (95% CIs) of 1.00 (1; 1.01), 1.02 (1; 1.05), 1.12 (1.11; 1.2), 1.11 (1.09; 1.2), and 1.13 (1.09; 1.17), respectively. Our study showed that, in countries with high TB burden like Vietnam, latent TB infection has high prevalence among patients with RA. We also provide useful information for the screening, monitoring, and treatment of latent and active TB infection in patients with RA.