Frequency and tolerance of antituberculosis treatment according to national guidelines for prevention of risk of tuberculosis due to tumor necrosis factor blocker treatment - 24/03/10
, Cécile Poulain a, b, Maxime Dougados a, b, Laure Gossec a, b
Corresponding author. Rheumatology Department, La Pitié-Salpétrière Hospital, 47-83, boulevard de l’Hôpital, 75651 Paris cedex 13, France. Tel.: +33 142177812; fax: +33 142177959.Bienvenue sur EM-consulte, la référence des professionnels de santé.
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Abstract |
Purpose |
Tumor necrosis factor (TNF) blockers increase the risk of tuberculosis infection. National recommendations in France for prevention of latent tuberculosis recommend treatment by rifampicin (RIF) 600mg/day and isoniazid (INH) 300mg/day for 3 months. However, its toxicity is unknown in this context and is a subject of debate.
Objective |
To assess (a) frequency of prescription, (b) reasons for prescription, (c) tolerance of INH/RIF for prevention of tuberculosis.
Methods |
Systematic retrospective study of medical records of one tertiary rheumatology unit, from 2002 to 2007, of all patients who were prescribed INH/RIF before receiving TNF blockers. Data collection: patients’demographic characteristics, reasons of prescription, tolerance and levels of aminotransferase before and during INH/RIF treatment.
Analysis |
Descriptive and determination of risk factors of hepatotoxicity by multivariate logistic regression.
Results |
Of 1028 patients treated by TNF blockers between 2002 and 2007, 216 (21.1%) received INH/RIF treatment. Of 93 patients with complete data, 17 (18.2%) presented hepatotoxicity of which only one above 10 times the upper limit of the norm. Fourteen (15.0%) had other side effects. Ten (10.7%) patients had to interrupt INH/RIF for intolerance. Factors predicting intolerance were male sex, aminotransferases before treatment, a higher body mass index and leflunomide comedication.
Conclusion |
This systematic case review indicates a high rate of necessity for preventive treatment by INH/RIF, and in particular for positive skin tests. This association had a high rate of hepatotoxicity without severe consequences. A better screening of patients before preventive therapy is needed.
Le texte complet de cet article est disponible en PDF.Keywords : TNF⍺ blockers, Rheumatic diseases, Tuberculosis, Prevention, Isoniazid, Rifampicin, Recommendations, Hepatotoxicity, Retrospective
Plan
Vol 77 - N° 2
P. 135-141 - mars 2010 Retour au numéro
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