TNF therapy for AS, PsA, SpA linked with increased incidence of tuberculosis

WASHINGTON — Patients with ankylosing spondyloarthritis, psoriatic arthritis and spondyloarthropathies who were treated with tumor necrosis factor inhibitors were seven-times more likely to develop tuberculosis than the general population, according to findings presented at the American College of Rheumatology Annual Meeting.

Mirjam K. de Vries, MD, of the Clinical Epidemiology Unit, Infectious Diseases Unit and Department of Medicine at the Karolinska Institutet in Stockholm, and colleagues aimed to assess the tuberculosis (TB) risk in patients with ankylosing spondyloarthritis (AS), psoriatic arthritis (PsA) and spondyloarthropathies (SpA) as a function of biological therapy, particularly anti-tumor necrosis factor (TNF) drugs.

“There are scarce data on TB incidence in AS, PsA and other spondyloarthropathies,” she said. “TNF inhibitors are increasingly associated with higher TB risks in these patients.”

The study included 38,702 patients from the Swedish National Patient, Population, TB and Rheumatology registers who were followed for TB incidence from 2002 to 2013.

“We aimed to estimate TB risk over time in these patients in relation to biologic treatment and compare that with risk in the general population,” de Vries said.

Researchers reported 11 cases of TB in the cohort, for incidence rates of 2.7 per 100,000 among biologic-naïve patients; 22 per 100,000 for biologic-experienced patients; and 2.4 per 100,000 among the general population. Comparison with the general population revealed that biologic-naïve patients carried a small risk (hazard ratio [HR] = 1.2) for TB, while the risk for exposed patients was significant (HR = 7.5). The rate of biologic drug use was 13% in this population, with 99% of those patients receiving TNF inhibitors.

“Biological therapy-naïve patients with AS, PsA and SpA treated with anti-TNF therapy are at an increased TB risk,” de Vries concluded. “Following treatment with biologicals, the risk increased.”

She acknowledged, however, that the absolute risk of TB was low in both the general population and in this particular population of patients with spondyloarthropathies.

“However, we have to remain alert, because TB remains a potentially life-threatening infection,” she said. – by Rob Volansky

Reference:

de Vries MK, et al. Abstract #2006. Presented at: the American College of Rheumatology Annual Meeting; Nov. 11-16, 2016; Washington.

Disclosure: de Vries reports no relevant financial disclosures.