Association of Tumor Necrosis Factor alpha Inhibitor Use with Diagnostic Features and Mortality of Tuberculosis in the United States, 2010-2017

• Authors: Shereen S Katrak, California Department of Public Health; Rongxia Li, Centers for Disease Control and Prevention, Atlanta; S Reynolds, Centers for Disease Control and Prevention, Atlanta; SM Marks, Centers for Disease Control and Prevention, Atlanta; JR Probst, Emory University; Terence Chorba, Centers for Disease Control and Prevention, Atlanta; Kevin Winthrop, Oregon Health and Science University; Kenneth Castro, Emory University; Neela Goswami, Emory University
• Journal Title: OPEN FORUM INFECTIOUS DISEASES
• Volume: Volume 9, Number 2
• Publisher: OXFORD UNIV PRESS INC | 2022-01-30, Pages ofab641-ofab641
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/ofid/ofab641
• Subjects: Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Microbiology; biologic; immunocompromised host; mycobacterial disease; tuberculosis; TNF-alpha inhibitor; FACTOR BLOCKERS; RISK; INFLIXIMAB; BIOLOGICS; DISEASES; THERAPY; PATIENT

Abstract

Background: An elevated risk of tuberculosis (TB) disease in persons who have received tumor necrosis factor alpha inhibitor medications (TNF-α inhibitors) has been reported for nearly two decades, but clinical diagnostic features and outcomes of TB in this population remain poorly described. Methods: We analyzed national surveillance data for TB cases among persons aged 15 years and older reported in the United States during 2010-2017 and associated mortality data reported through 2019 to describe the clinical characteristics of those receiving TNF-α inhibitors. Results: Of 70 129 TB cases analyzed, 504 (0.7%) of the patients had TNF-α inhibitor use reported at TB diagnosis. Patients with TNF-α inhibitor use at TB diagnosis were more likely than TB patients not receiving TNF-α inhibitors to have TB diagnosed in extrapulmonary sites in conjunction with pulmonary sites (28.8% vs 10.0%, P < .001). Patients receiving TNF-α inhibitors were less likely to have acid-fast bacilli noted on sputum smear microscopy (25.6% vs 39.1%, P = .04), and more likely to have drug-resistant disease (13.5% vs 10.0%, P < .001). TB-attributed deaths did not significantly differ between patients receiving and not receiving TNF-α inhibitors (adjusted odds ratio, 1.46 [95% confidence interval,. 95-2.26]). Conclusions: Clinicians evaluating TNF-α inhibitor-treated patients should have a high index of suspicion for TB and be aware that extrapulmonary or sputum smear-negative TB disease is more common in these patients. No significantly diminished survival of TB patients treated with TNF-α inhibitor therapy before TB diagnosis was noted.