RESEARCH - Risk and case characteristics of TB in RA associated with TNF antagonists in Sweden

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Arthritis Rheum. 2005 Jul;52(7):1986-92.

Risk and case characteristics of tuberculosis in rheumatoid arthritis

associated with tumor necrosis factor antagonists in Sweden.

Askling J, Fored CM, Brandt L, Baecklund E, Bertilsson L, Coster L, Geborek

P, sson LT, Lindblad S, Lysholm J, Rantapaa-Dahlqvist S, Saxne T,

Romanus V, Klareskog L, Feltelius N.

Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.

OBJECTIVE: Because treatment with tumor necrosis factor (TNF) antagonists

may increase the risk of tuberculosis (TB), and because knowledge of the

risk of TB in rheumatoid arthritis (RA) not treated with biologics is scarce

and of uncertain generalizability to low-risk populations, this study sought

to determine the risk of TB among Swedish patients with RA. METHODS: Using

data from Swedish nationwide and population-based registers and data from an

ongoing monitoring program of TNF antagonists, the relative risks of TB in

patients with RA (versus the general population) and of TB associated with

TNF antagonists (versus RA patients not treated with biologics) were

determined by comparing the incidence of hospitalization for TB in 3 RA

cohorts and 2 general population cohorts from 1999 to 2001. We also reviewed

the characteristics of all reported cases of TB in RA patients treated with

TNF antagonists in Sweden and calculated the incidence of TB per type of TNF

antagonist between 1999 and 2004. RESULTS: During 1999-2001, RA patients who

were not treated with TNF antagonists were at increased risk of TB versus

the general population (relative risk 2.0, 95% confidence interval [95% CI]

1.2-3.4). RA patients treated with TNF antagonists had a 4-fold increased

risk of TB (relative risk 4.0, 95% CI 1.3-12) versus RA patients not treated

with TNF antagonists. The reported TB cases during 1999-2004 in RA patients

exposed to TNF antagonists (9 infliximab, 4 etanercept, 2 both) were

predominantly pulmonary. TB occurred up to 3 years following the start of

treatment.

CONCLUSION: Irrespective of whether TNF antagonists are administered,

Swedish patients with RA are at increased risk of TB. During 1999-2001, TNF

antagonists were associated with an increased risk of TB, up to 4-fold in

magnitude. This increased risk may persist over time during treatment and is

related to both infliximab and etanercept.

PMID: 15986370

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5986370 & dopt=Abstract

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