Background: The long-term safety of therapeutic agents that neutralize tumor necrosis factor (TNF) is uncertain. Recent evidences show that treatment with tumor necrosis factor antagonists has been recognized as a risk factor for active tuberculosis (TB) in patients with rheumatoid arthritis (RA).
Aim of the work: The aim of this work was to assess the risk of active TB with other serious and non serious bacterial and viral infections in RA patients who are receiving conventional disease modifying anti rheumatic drugs (DMARDs) versus those who are receiving biological therapy.
Patients and methods: A prospective study conducted on (235) patients have rheumatoid arthritis RA, divided into two groups; group (A) included (105) RA patients receiving conventional disease modifying anti rheumatic drugs (DMARDs) with a mean age (51±12) and group (B) included (130) RA patients receiving biological therapy with a mean age (48±13) as (55) patients on infleximab, (32) patients on adalimumab, and (43) patients on etanercept. Assessment was done and included through medical history, clinical examination, chest x ray, HRCT chest, tuberculin skin test and sputum for acid fast bacilli (AFB). Those with latent TB were subjected for anti-tuberculosis Chemoprophylaxis.
Results: The prevalence of infectious complications was significantly more common in those who were receiving the biological therapy (39.2%) versus 15.2% for those who were receiving (DMARDs). Active TB was 2.5 times more in group (B). Other infections as respiratory tract infections, urinary tract infections, and herpes zoster were more common in those who were receiving biological therapy (29.2%, 4.6% and 3%), versus the other group (13.3, 0.9, and 0%) respectively.
Conclusion: From this study we concluded that the use of biological therapy in RA patients still raises a serious concern, namely the increased risk of infections, especially TB which demand specific and time-consuming measures before and during treatment. Chemoprophylaxis for patients on anti-TNF therapy was safe and partially prevents the reactivation of latent TB. |
