Paradoxical anti-TNF-associated TB worsening: Frequency and factors associated with IRIS

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• 作者：Claire Rivoisy^a ; ^{claire.rivoisy@sat.aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Florence Tubach^b ; ^c ; Carine Roy^b ; ^c ; Nathalie Nicolas^d ; ¹ ; Xavier Mariette^e ; Dominique Salmon^f ; Olivier Lortholary^g ; Anne Bourgarit^h ; ⁱ ; for the RATIO Group²
• 关键词：TNF-blockers ; Tuberculosis ; IRIS
• 刊名：Joint Bone Spine
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：83
• 期：2
• 页码：173-178
• 全文大小：366 K

文摘

Paradoxical tuberculosis (TB) worsening, an example of the immune reconstitution inflammatory syndrome (IRIS), is an increasing phenomenon now described in several settings, including anti-tumor necrosis factor (TNF) discontinuation during biotherapy-induced TB. To better recognize it, we analyzed the frequency and factors associated with anti-TNF-induced TB–IRIS.

Methods

Case-control study on anti-TNF-associated TB patients. IRIS cases, defined with the following consensus criteria, were matched to two controls (anti-TNF-associated TB without IRIS). IRIS frequency was based on the French RATIO registry. Conditional logistic-regression identified IRIS risk factors.

Results

Fourteen patients developed anti-TNF-associated TB–IRIS within medians of 45 [IQR 22–131] days after starting anti-TB therapy and 110 [IQR 63–164] days after the last anti-TNF infusion. Each case was matched to two controls by year of TB diagnosis. IRIS-associated factors were (odds ratio [95% CI]): disseminated TB (11.4 [1.4–92.2], P = 0.03), history of Mycobacterium tuberculosis exposure (12.7 [1.6–103.0], P = 0.02) and steroid use at the time of TB diagnosis (4.6 [1.2–17.2], P = 0.02). The RATIO registry IRIS frequency was 7%.

Conclusion

After stopping biotherapy, paradoxical anti-TNF-associated TB worsening occurred most often in patients with disseminated TB. Although diagnosis remains difficult, physicians must be aware of IRIS because prolonged anti-TB treatment is not needed but, paradoxically, immunosuppressant reintroduction may be.