Abstract
In this study, we investigated the safety and toxicity of isoniazid (INH) intervention therapy to the patients with latent tuberculosis who were given tumor necrosis factor α (TNFα) for the treatment of their rheumatologic diseases. In this prospective clinical study, we enrolled 86 patients receiving anti-TNFα therapy for their rheumatologic diseases between April 2005 and September 2006. Of all the subjects, 45 had rheumatoid arthritis, 36 had ankylosing spondylitis, and 5 had psoriatic arthritis. In addition to anti-TNFα therapy, 60 of the 86 patients were given INH intervention for revealed latent tuberculosis. INH at a dosage of 300 mg daily was given for 9 months. Hepatotoxicity due to the INH therapy was considered when the serum alanine aminotransferase (ALT) and/or aspartate aminotransaminase (AST) levels showed at least threefold increase with respect to their baseline serum levels. Serum ALT and AST levels were measured by enzymatic colorimetric method in fasting peripheral blood samples at 0 (baseline), 1, 2, 3, 6, and 9 months. Of 86 patients, 47 (54.7%) were women (mean age±SD, 44.1 ± 10.9 years) and 39 (45.3%) were men (38.8 ± 10.1 years). Except five patients (8.3%), liver toxicity due to the INH therapy was not encountered among the patients, and after temporarily discontinuing the INH therapy of these five subjects, serum transaminase levels returned to the normal ranges. No hepatotoxicity was observed in the non-INH group. However, there was no statistical significance between INH-treated and non-INH-treated group (p = 0.317). In addition, none of the 86 patients developed active tuberculosis infection during the treatment period. In conclusion, for those patients who were assigned to the TNFα treatment for their rheumatologic disorders and carrying risk for latent tuberculosis, INH intervention therapy was found to be safe and efficacious.
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References
Keane J (2005) TNF-blocking agents and tuberculosis: new drugs illuminate and old topic. Rheumatology 44:714–720
Ellerin T, Hurtado R, Lockman S et al (2003) Infections and anti-tumor necrosis factor alpha therapy. Arthritis Rheum 48(11):3013–3022
Kroesen S, Widmer AF, Tyndall A et al (2003) Serious bacterial infections in patients with rheumatoid arthritis under anti-TNF-alpha therapy. Rheumatology (Oxford) 42(5):617–621
Khanna D, McMahon M, Furst DE (2004) Safety of tumour necrosis factor-α antagonists. Drug Saf 27(5):307–324
Long R, Gardam M (2003) Tumour necrosis factor-α inhibitors and the reactivation of latent tuberculosis infection. CMAJ 168(9):1153–1156
Mutlu G, Mutlu E, Bellmeyer A et al (2006) Pulmonary adverse events of anti tumour necrosis factor-α antibody therapy. Am J Med 119:639–646
American Thoracic Society (2000) Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 61:S221–S247
British Thoracic Society Standards of Care Commitee (2005) BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-α treatment. Thorax 60:800–805
Vanhoof J, Landewe S, Wijngaerden E et al (2003) High Incidence of hepatotoxicity of isoniazid treatment for tuberculosis chemoprophylaxis in patients with rheumatoid arthritis treated with methotrexate or sulfasalazine and anti-tumour necrosis factor inhibitors. Ann Rheum Dis 62:1241–1242
Sichletidis L, Settas L, Spyratos D et al (2006) Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis. Int J Tuberc Lung Dis 10(10):1127–1132
Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324
van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–367
Kunst H (2006) Diagnosis of latent tuberculosis infection: the potential role of new technologies. Respir Med 100:2098–2106
Wolfe F, Michaud K, Anderson J et al (2004) Tuberculosis infection in patients with rheumatoid arthritis and the effect of infliximab therapy. Arthritis Rheum 50(2):372–379
American Thoracic Society, CDC, and Infectious Diseases Society of America (2003) MMWR vol 52. No. RR–11
Fountain F, Tolley E, Chrisman C et al (2005) Isoniazid hepatotoxicity associated with treatment of latent tuberculosis infection. Chest 128:116–123
American Thoracic Society Documents (2006) Ann official ATS statement: hepatotoxicity of antituberculosis therapy. Am J Respir Crit Care Med 174:935–952
Gaitonde S, Pathan E, Sule A et al (2002) Efficacy of isoniazid prophylaxis in patients with systemic lupus erythematosus receiving long term steroid treatment. Ann Rheum Dis 61:251–253
Vikrant S, Agarwal SK, Gupta S (2005) Prospective randomized control trial of isoniazid chemoprophylaxis during renal replacement therapy. Transpl Infect Dis 7(3–4):99–108
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Hanta, I., Ozbek, S., Kuleci, S. et al. Isoniazid intervention for latent tuberculosis among 86 patients with rheumatologic disease administered with anti-TNFα. Clin Rheumatol 26, 1867–1870 (2007). https://doi.org/10.1007/s10067-007-0591-4
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DOI: https://doi.org/10.1007/s10067-007-0591-4