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Use of Immunosuppressants in Patients with Autoimmune Diseases and Latent Tuberculosis
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A5562 - Use of Immunosuppressants in Patients with Autoimmune Diseases and Latent Tuberculosis
Author Block: M. Pombo, D. Burgos, E. S. Membriani, L. Limongi, A. M. Putruele; Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
Patients with autoimmune conditions have mechanisms which increase the risk of infection by the disease itself and by the treatments they perform. The use of immunosuppressants increase the risk in the reactivation of latent tuberculosis (LTB), so the screening and treatment become fundamental pillars for disease control. In our country IGRA tests are not available. A prospective study has been conducted to register the incidence of LTB in adults with autoimmune diseases and immunosuppressive treatment, with the aim of evaluating whether receiving treatment with isoniazid brings higher benefits than no treatment at all, as well as the associated risks, such as hepatotoxicity. Materials and methods: A longitudinal, descriptive, observational follow-up for was carried out in a University Hospital during 5 years. Ninety-one patients were evaluated, of which 70 had LTB and were receiving immunosuppressant treatment and were in process of beginnign a 2nd or 3rd line of immunosuppressive treatment. Of the cohort, 63 patients were treated with isoniazid (H) while 7 did not receive it for different reasons. Results: The population was predominantly female, with an average age of 51.2 years; the most frequent pathologies were rheumatoid arthritis and psoriasis, and the most frequently treatments were adalimumab and etanercept, followed by other immunosuppressants such as methotrexate (MTX) and meprednisone. Prophylaxis was completed in 67% of the randomized sample and the PPD values of the group that did not receive H were lower (8.5 vs. 11.47). In the treated group, 4 patients showed hepatotoxicity, forcing to suspend the given medication (3 of them were treated with MTX) and 1 patient presented cutaneous toxicity. During the study period, no patient with TB were registered in any of the groups. Conclusion: More studies are needed to establish if the benefit of the treatment exceeds its risks and the search for new treatments with alternative schemes will become another fundamental pillar. As mentioned before, there is a risk of hepatotoxicity, particularly increased with the use of MTX, so that we think that this group needs to be closer monitored.
Author Block: M. Pombo, D. Burgos, E. S. Membriani, L. Limongi, A. M. Putruele; Hospital de Clínicas José de San Martín, Buenos Aires, Argentina.
Patients with autoimmune conditions have mechanisms which increase the risk of infection by the disease itself and by the treatments they perform. The use of immunosuppressants increase the risk in the reactivation of latent tuberculosis (LTB), so the screening and treatment become fundamental pillars for disease control. In our country IGRA tests are not available. A prospective study has been conducted to register the incidence of LTB in adults with autoimmune diseases and immunosuppressive treatment, with the aim of evaluating whether receiving treatment with isoniazid brings higher benefits than no treatment at all, as well as the associated risks, such as hepatotoxicity. Materials and methods: A longitudinal, descriptive, observational follow-up for was carried out in a University Hospital during 5 years. Ninety-one patients were evaluated, of which 70 had LTB and were receiving immunosuppressant treatment and were in process of beginnign a 2nd or 3rd line of immunosuppressive treatment. Of the cohort, 63 patients were treated with isoniazid (H) while 7 did not receive it for different reasons. Results: The population was predominantly female, with an average age of 51.2 years; the most frequent pathologies were rheumatoid arthritis and psoriasis, and the most frequently treatments were adalimumab and etanercept, followed by other immunosuppressants such as methotrexate (MTX) and meprednisone. Prophylaxis was completed in 67% of the randomized sample and the PPD values of the group that did not receive H were lower (8.5 vs. 11.47). In the treated group, 4 patients showed hepatotoxicity, forcing to suspend the given medication (3 of them were treated with MTX) and 1 patient presented cutaneous toxicity. During the study period, no patient with TB were registered in any of the groups. Conclusion: More studies are needed to establish if the benefit of the treatment exceeds its risks and the search for new treatments with alternative schemes will become another fundamental pillar. As mentioned before, there is a risk of hepatotoxicity, particularly increased with the use of MTX, so that we think that this group needs to be closer monitored.
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