Shiang-Fen Huang1, Ming-Han Chen2, Fu-Der Wang3, Chang-Youh Tsai4, Chang-Phone Fung5, Wei-Juin Su6. 1. Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taiwan, ROC. Electronic address: sfhuang.dr@gmail.com. 2. Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC. Electronic address: meikankimo@yahoo.com.tw. 3. Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taiwan, ROC. Electronic address: fdwang@vghtpe.gov.tw. 4. Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC. Electronic address: cytsai@vghtpe.gov.tw. 5. Institution of Clinical Medicine, National Yang-Ming University, Taiwan, ROC; Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan, ROC. Electronic address: cpfung@vghtpe.gov.tw. 6. School of Medicine, National Yang-Ming University, Taiwan, ROC; Department of Chest Medicine, Taipei Veterans General Hospital, Taiwan, ROC. Electronic address: wjsu@vghtpe.gov.tw.
Abstract
BACKGROUND: Active tuberculosis (TB) in patients with latent tuberculosis infection (LTBI) was associated with use of biological agents for immune-mediated inflammatory disorders (IMIDs). For decreasing active TB, isoniazid prophylaxis therapy was administered before biologic therapy among IMID patients with LTBI. However, for patients who had been received biologics for a long time with unknown status of LTBI or exposure history of active TB, the prevalence of LTBI and efficacy of isoniazid therapy were unclear. METHOD: A retrospective cohort study was conducted during 2012-2014 in a tertiary medical center in Taiwan, and the incidence case of active TB was identified by the national TB registration system on October 1, 2015. RESULTS: All 382 patients with 1532 person-years were followed up, the initial prevalence of LTBI by positive interferon-gamma releasing assay (IGRA+) was 17.5%. The prevalence of LTBI was increased in elder age (>20%, p < 0.05), chronic kidney disease (33%, p < 0.05), metabolic syndrome (26.3%, p < 0.05), but not related to the type of IMIDs or biologics. The crude incidences of TB were increased in elders (53.3/1000 person-year), abnormal chest film (49.6/1000 person-year), administration of tocilizumab (13.6/1000 person-year), and metabolic syndrome (56.1/1000 person-year), respectively. Among patents with LTBI, the incidence of active TB was lower in patients with isoniazid therapy (9.2/1000 person-year, p = 0.02) than without isoniazid therapy (92.2/1000 person-years), regardless the timing of initiating isoniazid therapy (p > 0.05). CONCLUSION: Isoniazid therapy can prevent active TB from LTBI despite of the timing of biologics administration.
BACKGROUND: Active tuberculosis (TB) in patients with latent tuberculosis infection (LTBI) was associated with use of biological agents for immune-mediated inflammatory disorders (IMIDs). For decreasing active TB, isoniazid prophylaxis therapy was administered before biologic therapy among IMID patients with LTBI. However, for patients who had been received biologics for a long time with unknown status of LTBI or exposure history of active TB, the prevalence of LTBI and efficacy of isoniazid therapy were unclear. METHOD: A retrospective cohort study was conducted during 2012-2014 in a tertiary medical center in Taiwan, and the incidence case of active TB was identified by the national TB registration system on October 1, 2015. RESULTS: All 382 patients with 1532 person-years were followed up, the initial prevalence of LTBI by positive interferon-gamma releasing assay (IGRA+) was 17.5%. The prevalence of LTBI was increased in elder age (>20%, p < 0.05), chronic kidney disease (33%, p < 0.05), metabolic syndrome (26.3%, p < 0.05), but not related to the type of IMIDs or biologics. The crude incidences of TB were increased in elders (53.3/1000 person-year), abnormal chest film (49.6/1000 person-year), administration of tocilizumab (13.6/1000 person-year), and metabolic syndrome (56.1/1000 person-year), respectively. Among patents with LTBI, the incidence of active TB was lower in patients with isoniazid therapy (9.2/1000 person-year, p = 0.02) than without isoniazid therapy (92.2/1000 person-years), regardless the timing of initiating isoniazid therapy (p > 0.05). CONCLUSION:Isoniazid therapy can prevent active TB from LTBI despite of the timing of biologics administration.