Preventing tuberculosis in children receiving anti-TNF treatment.

Medical Faculty, Pediatric Rheumatology Unit, Acibadem University, Ankara, Turkey.
Clinical Rheumatology (Impact Factor: 1.77). 04/2010; 29(4):389-92. DOI: 10.1007/s10067-009-1334-5
Source: PubMed

ABSTRACT Anti-tumor necrosis factor (TNF) treatment has been a breakthrough in the management of juvenile idiopathic arthritis (JIA). However, they are associated with a significant risk of tuberculosis. We evaluated JIA patients who received etanercept treatment from an eastern Mediterranean country with moderate tuberculosis frequency. JIA patients under anti-TNF treatment, etanercept, were enrolled to the study. Chest X-rays, Tuberculin Skin Test (TST), clinical histories, family screening, and physical examinations were reviewed retrospectively. If TST was above 10 mm in a patient with one Bacillus Calmette-Guerin, cultures and, if needed, thorax computerized tomography were obtained. These patients received 1-2 months of isoniazid (INH) treatment which was followed by an INH prophylaxis for a period of 9 months while etanercept treatment was started. All were re-evaluated within 3 months intervals. A total of 36 patients under etanercept treatment were enrolled to the study. Mean age of the patients was 14.00 years (range 4-22 years). Median duration of disease was 36.00 months (range 4-216 months). Median duration of etanercept therapy was 11.5 months (3-48 months) at final evaluation. Seven patients had an initial TST score above 10 mm. All received INH treatment as outlined above. They had normal examinations and X-rays during followup. With proper initial evaluation, anti-TNF treatment is safe even in countries where tuberculosis is moderately frequent. An initial 1-2 months of INH treatment followed by chemoprophylaxis for 9 months is suggested for children with a TST of >10 mm.

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    • "However, a positive tuberculin skin test does not preclude the use of anti-TNF agents, particularly if they are necessary to prevent disease progression. Completing at least the first month of a 9-month course of isoniazid therapy would be prudent, prior to initiating treatment with adalimumab.66,67 "
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