Safety of resuming tumor necrosis factor inhibitors in ankylosing spondylitis patients concomitant with the treatment of active tuberculosis: A retrospective nationwide registry of the Korean Society of spondyloarthritis research

Hye Won Kim, Seong Ryul Kwon, Kyong Hee Jung, Seong Kyu Kim, Han Joo Baek, Mi Ryung Seo, So Young Bang, Hye Soon Lee, Chang Hee Suh, Ju Yang Jung, Chang Nam Son, Seung Cheol Shim, Sang Hoon Lee, Seung Geun Lee, Yeon Ah Lee, Eun Young Lee, Tae Hwan Kim, Yong Gil Kim, Kwi Young Kang, Mi Il KangBon San Koo, Dam Kim, You Jae Kim, Joong Gon Kim, Jin Ju Kim, Tae Jong Kim, Hyung Jin Kim, Hee Jung Ryu, Hyun Jeong Yoo, Ye Soo Park, Min Chan Park, Chang Bum Bae, Young Ho Seo, Duk Hyun Sung, Yoon Kyoung Sung, Ran Song, Kichul Shin, Dong Hyuk Sheen, Ji Min Oh, Tae Seok Yoo, Sang Yeob Lee, Sang Heon Lee, Seunghun Lee, Jaejoon Lee, Jae Myung Lee, Mi Kyoung Lim, Sung Hae Chang, Hyemin Jeong, Soo Kyung Cho, Hyun Jung Cho, Mi La Cho, Young Bin Joo, Hoon Suk Cha, Seong Jae Choi, Ji Young Choi, Chan Bum Choi, Hyo Jin Choi, Seung Jae Hong, Ji Won Hwang, Seok Chan Hong

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Abstract

Backgrounds Patients who develop an active tuberculosis infection during tumor necrosis factor (TNF) inhibitor treatment typically discontinue TNF inhibitor and receive standard anti-tuberculosis treatment. However, there is currently insufficient information on patient outcomes following resumption of TNF inhibitor treatment during ongoing anti- tuberculosis treatment. Our study was designed to investigate the safety of resuming TNF inhibitors in ankylosing spondylitis (AS) patients who developed tuberculosis as a complication of the use of TNF inhibitors. Methods Through the nationwide registry of the Korean Society of Spondyloarthritis Research, 3929 AS patients who were prescribed TNF inhibitors were recruited between June 2003 and June 2014 at fourteen referral hospitals. Clinical information was analyzed about the patients who experienced tuberculosis after exposure to TNF inhibitors. The clinical features of resumers and non-resumers of TNF inhibitors were compared and the outcomes of tuberculosis were surveyed individually. Findings Fifty-six AS patients were treated for tuberculosis associated with TNF inhibitors. Among them, 23 patients resumed TNF inhibitors, and these patients were found to be exposed to TNF inhibitors for a longer period of time and experienced more frequent disease flare-up after discontinuation of TNF inhibitors compared with those who did not resume. Fifteen patients resumed TNF inhibitors during anti-tuberculosis treatment (early resumers) and 8 after completion of anti-tuberculosis treatment (late resumers). Median time to resuming TNF inhibitor from tuberculosis was 3.3 and 9.0 months in the early and late resumers, respectively. Tuberculosis was treated successfully in all resumers and did not relapse in any of them during follow-up (median 33.8 [IQR; 20.8-66.7] months). Conclusions Instances of tuberculosis were treated successfully in our AS patients, even when given concomitantly with TNF inhibitors. We suggest that early resumption of TNF inhibitors in AS patients could be safe under effective coverage of tuberculosis.

Original languageEnglish
Article numbere0153816
JournalPLoS ONE
Volume11
Issue number4
DOIs
StatePublished - 2016 Apr

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    Kim, H. W., Kwon, S. R., Jung, K. H., Kim, S. K., Baek, H. J., Seo, M. R., Bang, S. Y., Lee, H. S., Suh, C. H., Jung, J. Y., Son, C. N., Shim, S. C., Lee, S. H., Lee, S. G., Lee, Y. A., Lee, E. Y., Kim, T. H., Kim, Y. G., Kang, K. Y., ... Hong, S. C. (2016). Safety of resuming tumor necrosis factor inhibitors in ankylosing spondylitis patients concomitant with the treatment of active tuberculosis: A retrospective nationwide registry of the Korean Society of spondyloarthritis research. PLoS ONE, 11(4), [e0153816]. https://doi.org/10.1371/journal.pone.0153816