LAUSR

Background Tuberculosis (TB) is a major concern in patients receiving TNF inhibitors (TNFi). Objectives To assess the incidence of active TB and the efficacy of TB prevention measures in a large, single-center cohort of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) receiving TNFi. Methods Data of all patients in whom treatment with TNFi was initiated in our rheumatology clinic from January 1st 2002 until December 31st 2015 have been retrospectively analysed. The cohort was divided into 2 groups per the mandatory latent TB infection (LTBI) screening method at baseline: tuberculin skin test (group TST), and QuantiFERON®-TB Gold test (group QFT). The incidence of active TB was analysed for each group and compared to TB incidence data in general population. Results 653 patients were included (344 RA, 52 PsA, 257 AS); 324 patients belonged to the TST and 329 to the QFT group. The number of active TB cases/ time of exposure to TNFi (person-years, PY) was 17/2002.6 and 7/1041.2 respectively, accounting for an incidence of 848.9 and 672.3 cases per 105 PY, about 8 times higher (8.3 and 8.8 for TST, respectively QFT group) than the average TB during the period of exposure to TNFi. LTBI reactivations per total TB cases were only 4/17 and 2/7, respectively, too few to identify statistically significant differences between the 2 LTBI screening protocols. Only 10 patients had pulmonary TB, whereas the rest were disseminated TB (8 cases), TB pleurisy and/or pericarditis (4 cases), one mediastinal lymph node TB and one isolated hepatic TB. Using Pearson chi-square test, we found no significant differences between LTBI group and active TB (Table 1).Table 1. LTBI screening results and TB occurrence in the 653 TNFi-treated patients (Pearson χ2 test) TST QFT All p value (n=324) (n=329) (n=653) Positive immuno-diagnostic test at baseline 52 (16.0%) 63 (19.1%) 115 (17.6%) <0.001* Active TB 17 (5.2%) 7 (2.1%) 24 (3.7%) 0.185* Reactivation TB 4 (1.2%) 2 (0.6%) 6 (0.9%) ** New infection TB 13 (4.0%) 5 (1.5%) 18 (2.8%) 0.052* Total TB incidence (per 105 PY) 848.9 672.3 788.5 – Maximal period of TNFi exposure in group 2002–2016 2011–2016 2002–2016 – Mean TB incidence in Romania in the respective time period (per 105 PY) 102.3 76.7 102.3 – TB incidence patients/general population 8.3 8.8 7.7 0.88† *Pearson χ2test comparing TST and QFT. **Reactivation TB cases were too few to perform statistical testing. †Pearson χ2test comparing total TB incidence in the TST and QFT groups to the average TB incidence in our region in the respective period of exposure. Conclusions In our cohort, new infection TB exceeds reactivation TB, suggesting the necessity of periodical LTBI re-screening. Disclosure of Interest A. M. Gheorghiu: None declared, A. Garaiman: None declared, A. Radu: None declared, A. Soare: None declared, V. Aramă: None declared, D. Bumbăcea: None declared, R. Dobrotă: None declared, R. Oneata: None declared, S. Pintilie: None declared, M. Milicescu Speakers bureau: Has received sponsoring from Abbvie, MSD and Pfizer., I. Ancuta Grant/research support from: Abbvie, Pfizer, Roche, UCB, BMS, Consultant for: Abbvie, Pfizer, Roche, UCB, BMS, Speakers bureau: Abbvie, Pfizer, Roche, UCB, BMS, A. Martin Grant/research support from: Abbvie, MSD, Pfizer, Roche, UCB, BMS, M. Sasu Grant/research support from: Abbvie, MSD, Pfizer, Roche, UCB, BMS, C. Ciofu Grant/research support from: Abbvie, MSD, L. Macovei Grant/research support from: MSD, Pfizer, Roche, V. Stoica: None declared, M. Bojinca Grant/research support from: Abbvie, MSD, Pfizer, Roche, UCB, BMS, Consultant for: Abbvie, MSD, Pfizer, Roche, UCB, BMS, Paid instructor for: Abbvie, MSD, Pfizer, Roche, UCB, BMS, C. Mihai Grant/research support from: Abbvie, MSD, Pfizer, Roche, UCB, BMS, Consultant for: Abbvie, MSD, Speakers bureau: Abbvie, MSD, Pfizer, Roche, UCB, BMS