SESSION TITLE: TB
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 27, 2013 at 03:00 PM - 04:00 PM
PURPOSE: Anti-TNF therapy increases the risk of tuberculosis (TB), but whether it affects the risk of nontuberculous mycobacterial (NTM) disease is unclear.
METHODS: We conducted a cohort study, following all residents of Ontario, Canada aged >65 years from January 2001 to December 2010. We assessed the risk of TB and NTM disease associated with anti-TNF therapy in all subjects and amongst a subpopulation with rheumatoid arthritis (RA; defined using a validated algorithm based on hospital discharge abstracts and physician service claims). We obtained data on all cases of laboratory-confirmed mycobacterial infection from Public Health Ontario Laboratory.
RESULTS: In our study population, 3,481 patients had ever used anti-TNF agents and 2,666,961 had not. Among anti-TNF ever-users, 82% had RA. We observed TB case rates among anti-TNF ever-users and never-users of 31.7 (95%CI: 12.7-65.4) and 6.9 (95%CI: 6.5-7.3) per 100,000 person-years, respectively, for a rate ratio (RR; comparing anti-TNF ever-users to never-users) of 4.62 (95%CI: 2.20-9.71). In contrast, we observed NTM disease rates among anti-TNF ever-users and never-users of 81.8 (95%CI: 48.5-129.3) and 27.6 (95%CI: 26.8-28.4) per 100,000 person-years, respectively, for a RR of 2.96 (95%CI: 1.86-4.70). Among the RA subpopulation, we observed TB case rates among anti-TNF ever-users and never-users of 41.6 (95% CI: 16.7-85.7) and 10.2 (95%CI: 6.9-14.5) per 100,000 person-years, respectively, for a RR of 4.08 (95%CI: 1.80-9.27). Among the RA subpopulation, we observed NTM disease rates among anti-TNF ever-users and never-users of 89.4 (95%CI: 50.0-147.4) and 60.3 (95%CI: 51.9-69.7) per 100,000 person-years, respectively, for a RR of 1.48 (95%CI: 0.88-2.51).
CONCLUSIONS: In Ontario, NTM disease occurs more frequently than TB in anti-TNF users. Anti-TNF therapy is associated with an increased risk of mycobacterial infections, and the increased risk may be greater for TB than NTM disease. In RA patients, anti-TNF therapy increases the risk of TB, but not NTM disease.
CLINICAL IMPLICATIONS: Anti-TNF therapy is a risk factor for mycobacterial disease. RA patients are at elevated risk of NTM, but that risk is not substantially altered by anti-TNF therapy.
DISCLOSURE: The following authors have nothing to disclose: Sarah Brode, Frances Jamieson, Ryan Ng, Michael Campitelli, Jeff Kwong, J. Paterson, Ping Li, Alexandre Marchand-Austin, Claire Bombardier, Theodore Marras
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