Tuberculosis screening in pediatric patients receiving TNF-alpha inhibitor therapy

Abstract

Tumor necrosis factor-alpha inhibitors (TNFIs) increase the risk of tuberculosis (TB). The aim of this study was to evaluate pediatric patients who are under TNFIs regarding the emergence of TB, and to determine the effectiveness of screening methods. This was a retrospective observational study of 73 patients receiving TNFIs therapy for at least 6 months duration between January 2011 and January 2016. Detailed demographic and clinical data were gathered from patients' files. Seventy-three patients (female n=41, 56.2%) with a median age of 129 (38-215) months were enrolled. Median follow-up period was 18 (6-60) months. Median duration of primary illness prior to TNFI therapy was 24 (2-184) months. Sixteen patients (21.9%) with latent tuberculosis infection (LTBI) were given isoniazid (INH) prior to TNFI therapy. TNFIs were adalimumab (n=39, 53.5%), infliximab (n=22, 30.1%) and etanercept (n=12, 16.4%). During follow-up, 16 patients (21.9%) were started on INH treatment. Median time of starting INH was 20 (4-42) months. One patient (3.1%) who received INH had elevated liver transaminases. One patient (1.3%) developed active TB during follow-up. In conclusion, patients who are candidates for TNFI treatment should be screened for TB before and during therapy.