Akademik Veri Yönetim Sistemi
British Pharmacological Society (BPS), London, İngiltere, 11 - 13 Aralık 2017, ss.1
Introduction: The relative risk of granulomatous infections, particularly tuberculosis,
is elevated during treatment with immunosuppressive drugs like anti-tumor necrosis
factor-alpha (anti-TNF-α) agents (1), though the risk was shown to be paradoxically
lower with concurrent use of corticosteroids, which is another immunosuppressive
class (2). This study aimed to examine the effect of concomitant immunosuppressive
drug use on the relative risk of tuberculosis due to anti-TNF-α in patients with
rheumatologic diseases in Turkey.
Method: This retrospective cohort study included patients with rheumatologic
diseases that were managed with anti-TNF-α therapy, as registered in the Prescription
Information System of Turkish Medicines and Medical Devices Agency between
2013 and 2015. One-year use of anti-TNF-α with our without immunosuppressive
drugs was analyzed based on tuberculosis status, i.e. TB(+) or TB(-) patients.
Results: Out of 7925 patients with rheumatologic conditions treated with anti-TNF-α
drugs, we identified 169 cases with granulomatous infection (21 cases per 1,000
patients), among which seven patients had tuberculosis (4.1%). Concomitant
immunosuppressive drug use was detected in 2356 patients (29.7%). Stratification of
the patients by tuberculosis status showed additional immunosuppressive drug use in
71.4% of TB(+) patients (n=7) compared with 29.6% of that in TB(-) (n=7918,
p=0.0276). However, further analysis on prescriptions showed that mean number of
immunosuppressive drug item per prescription was significantly higher in TB(-)
group (1.2 ± 0.2 items) than in TB(+) group (0.1 ± 0.3 items, p<0.0001). In addition,
these groups did not differ in terms of the mean number of immunosuppressive drug
box per prescription (3.8 ± 4.3 vs. 3.9 ± 2.6, respectively; p=0.9529).
Conclusion: Despite higher prevalence of immunosuppressive drug use among
patients who had tuberculosis, both patient groups who did or did not develop
tuberculosis under one-year anti-TNF-α therapy seem to be similarly exposed to
immunosuppressive drugs. These findings suggest that concomitant
immunosuppressive drug use does not appear to play a substantial role in raising the
risk of tuberculosis secondary to the use of anti-TNF-α drugs.