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Clinical Characteristics of Tuberculosis Patients Who Were on Therapy of Tumor Necrozing Factor Alpha Antagonists FREE TO VIEW

Tulin Cagatay, MD; Zuleyha Bingol, MD; Zeynep Yegin, MD; Gulfer Okumus, MD; Esen Kiyan, MD; Orhan Arseven, MD; Feyza Erkan, MD; Ziya Gulbaran, MD; Mustafa Erelel, MD; Turhan Ece, MD; Zeki Kilicaslan, MD
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Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

Chest. 2014;145(3_MeetingAbstracts):137A. doi:10.1378/chest.1888702
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SESSION TITLE: Tuberculosis Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Tuberculosis prevelance of patients who were on therapy of tumor necrozing factor antagonists (TNF) was 449/100.000. Here we evaluated the clinical characteristics of our patients who had tuberculosis infection during the therapy of TNF antagonists.

METHODS: Patient’s demographics, smoking history, underlying disease and disease duration, history of tuberculosis (contact, tuberculin skin test, prophylaxis of isoniazid), type of TNF antagonist and duration and the other immunsupressive drugs were recorded.

RESULTS: Files of 1794 patients followed between August 2005-June 2013 were evaluated. Tuberculosis was detected in 20 patients (%1). Most of our patients were male (%65, n=13). Mean age was 42.3±10.41years. Most of them were smokers (%70, 18.8±14.5 pack-year) and %35 were active smokers. Endication for TNF antagonists were; ankylosing spondylitis (%40, n=8), Crohn disease (%25, n=5), rheumatoid arthritis (%10, n=2), Behcet disease (%10, n=2), psoriatic arthritis (%10, n=2), hidroadenitis suppurativa (%5, n=1). Infliximab is the most common used (%50, n=10) TNF antagonist. Contact with tuberculosis was reported in 25% (n=5) of our patients. Only one patient reported tuberculosis disease in the past history. All patients had TST and chest graphy before TNF therapy. Patients with TST ≥5 mm and fibrotic lesion sequelae on chest graphy were given p.o 300mg isoniazid prophylaxis for 9 months (%90, n=17). Baseline TST was 9.7±6.7. Tuberculosis was growth 25.1±24.9 months after TNF antagonist usage. Most of our patients had pulmonary tuberculosis (% 65, n=13) MOTT was growth in one of these patient’ culture. Seven patients had extrapulmonary tuberculosis. Immunsupressive therapy (methotrexate, azathioprine, cyclosporine) were given to 55% of the patients.

CONCLUSIONS: Although isoniazid chemoprophylaxis was given to the patient using TNF antagonists. Tuberculosis disease was detected in high frequency.

CLINICAL IMPLICATIONS: Tuberculosis prevelance of patients who were on therapy of tumor necrozing factor antagonists was 449/100.000. In our study population tuberculosis prevelance was higher than the literatüre although isoniazid chemoprophylaxis was given.

DISCLOSURE: The following authors have nothing to disclose: Tulin Cagatay, Zuleyha Bingol, Zeynep Yegin, Gulfer Okumus, Esen Kiyan, Orhan Arseven, Feyza Erkan, Ziya Gulbaran, Mustafa Erelel, Turhan Ece, Zeki Kilicaslan

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