Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis

Int J Tuberc Lung Dis. 2006 Oct;10(10):1127-32.


Setting: A major concern surrounding the use of tumor necrosis factor-alpha (TNF-alpha) inhibitors is their potential to increase the risk of opportunistic infections, particularly tuberculosis (TB).

Objective: To estimate the incidence of active TB in patients with rheumatic diseases receiving anti-TNF drug therapy and to evaluate the effectiveness of an antituberculosis chemoprophylaxis regimen.

Design: Retrospective study of the files of 613 patients with rheumatic diseases who had received anti-TNF agent (etanercept, infliximab and adalimumab) therapy from July 2000 to June 2004 at the Aristotle University of Thessaloniki, Greece. All patients had a tuberculin skin test (TST) and a postero-anterior chest radiograph (CXR) prior to anti-TNF therapy. When indicated (TST > or =10 mm and/or fibrotic lesions on CXR), treatment for latent TB was established (6 months isoniazid [INH] or 3 months INH and rifampicin [RMP]). Anti-TNF agent therapy was started again 2 months later.

Results: Of 45 patients who fulfilled the criteria for chemoprophylaxis, only 36 were treated correctly. Eleven patients developed active TB 2-35 months after the beginning of anti-TNF therapy. Six patients developed pulmonary and five extra-pulmonary TB. Eight of these had received infliximab and three adalimumab.

Conclusion: The incidence of active TB in this study population was estimated at 449 cases per 100,00 population annually. Anti-tuberculosis chemoprophylaxis was only of partial preventive success in these patients.

MeSH terms

  • Adalimumab
  • Adult
  • Aged
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents / therapeutic use*
  • Antitubercular Agents / therapeutic use*
  • Arthritis / drug therapy
  • Arthritis / epidemiology*
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / epidemiology
  • Comorbidity
  • Etanercept
  • Female
  • Greece / epidemiology
  • Humans
  • Immunoglobulin G / therapeutic use
  • Incidence
  • Infliximab
  • Isoniazid / therapeutic use
  • Male
  • Middle Aged
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Retrospective Studies
  • Rifampin / therapeutic use
  • Spondylitis, Ankylosing / drug therapy
  • Spondylitis, Ankylosing / epidemiology
  • Tuberculosis / epidemiology*
  • Tuberculosis / prevention & control
  • Tuberculosis, Pulmonary / epidemiology


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antirheumatic Agents
  • Antitubercular Agents
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Infliximab
  • Adalimumab
  • Etanercept
  • Isoniazid
  • Rifampin