Balancing Effective Treatments With Potential Threats: The Impact of Biologic Agent Use on Tuberculosis Development in Children With Chronic Inflammatory Disorders

IF 2 4区医学 Q2 RHEUMATOLOGY International Journal of Rheumatic Diseases Pub Date : 2025-02-24 DOI:10.1111/1756-185X.70145

Ayse Hitay Telefon, Merve Kilic Cil, Gulsum Sonmez, Elif Afat Turgut, Tugba Kandemir Gulmez, Didem Gulcu Taskin, Sevinc Garip, Rabia Miray Kisla Ekinci, Umit Celik

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Abstract

Aim

We aimed to investigate the frequency and clinical characteristics of tuberculosis in pediatric patients receiving both anti-TNF-alpha and other biological agents.

Materials and Methods

The data of 270 patients who used biological agents due to rheumatologic diseases and inflammatory bowel disease (IBD) and were followed between January 2021 and October 2023 were retrospectively collected from their files.

Results

Of the patients, 138(51.1%) were female, 132(48.9%) were male. The mean age at diagnosis was 107 months (min 8–max 215 months). Patients were most commonly followed for juvenile idiopathic arthritis (JIA) (191 patients, 70.7%), followed by other autoinflammatory diseases (49 patients) and IBD (26 patients, 9.6%). Treatments included adalimumab (97 patients, 35.9%), etanercept (85 patients, 31.5%), canakinumab (33 patients, 12.2%), tocilizumab (31 patients, 11.5%), infliximab (16 patients, 5.9%), anakinra (5 patients, 1.9%), tofacitinib (2 patients, 0.7%), and rituximab (1 patient, 0.4%). During follow-up, latent tuberculosis infection (LTBI) developed in 5 (1.9%) patients. Three of these patients had JIA (using adalimumab, etanercept and tocilizumab), one had Familial Mediterranean Fever (using canakinumab), and one had IBD (using adalimumab). The mean duration of biological agent treatment until LTBI development was 14.6 months (min 6–max 29 months). Tuberculosis disease was diagnosed in two patients. Both were patients followed up due to IBD. One of the patients was diagnosed with miliary tuberculosis after infliximab treatment, while the other was followed for tuberculosis lymphadenitis after adalimumab treatment. Quadruple anti-tuberculosis therapy was initiated for the patients.

Conclusion

The use of biological agents has revolutionized the course of chronic inflammatory diseases in childhood. However, in these patients, monitoring for tuberculosis risk is crucial.

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平衡有效治疗与潜在威胁：生物制剂使用对慢性炎症性疾病儿童结核病发展的影响

目的探讨同时接受抗tnf - α和其他生物制剂治疗的儿科患者结核病的发病率和临床特点。材料与方法回顾性收集2021年1月至2023年10月期间因风湿病和炎症性肠病（IBD）使用生物制剂的270例患者的资料。结果女性138例（51.1%），男性132例（48.9%）。诊断时平均年龄为107个月（最小8 -最大215个月）。最常见的随访患者为幼年特发性关节炎（JIA） 191例（70.7%），其次为其他自身炎症性疾病（49例）和IBD（26例，9.6%）。治疗包括阿达木单抗（97例，35.9%）、依那西普（85例，31.5%）、canakinumab（33例，12.2%）、tocilizumab（31例，11.5%）、英夫利昔单抗（16例，5.9%）、阿那那单抗（5例，1.9%）、托法替尼（2例，0.7%）和利妥昔单抗（1例，0.4%）。随访期间，5例（1.9%）患者出现潜伏性结核感染（LTBI）。其中3例患者患有JIA（使用阿达木单抗、依那西普和托珠单抗），1例患有家族性地中海热（使用canakinumab）， 1例患有IBD（使用阿达木单抗）。生物制剂治疗至LTBI发展的平均持续时间为14.6个月（最小6 -最大29个月）。两名患者被诊断患有肺结核。两例患者均因IBD随访。1例患者在英夫利昔单抗治疗后被诊断为军性结核病，另1例患者在阿达木单抗治疗后被随访为结核性淋巴结炎。对患者进行四联抗结核治疗。结论生物制剂的应用彻底改变了儿童慢性炎性疾病的治疗过程。然而，对这些患者进行结核病风险监测至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Rheumatic Diseases RHEUMATOLOGY-

CiteScore

3.70

自引率

4.00%

发文量

362

审稿时长

1 months

期刊介绍： The International Journal of Rheumatic Diseases (formerly APLAR Journal of Rheumatology) is the official journal of the Asia Pacific League of Associations for Rheumatology. The Journal accepts original articles on clinical or experimental research pertinent to the rheumatic diseases, work on connective tissue diseases and other immune and allergic disorders. The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer reviewed by two anonymous reviewers and the Editor.