| الوصف: |
Background: Tuberculosis (TB) may be increased with biologic therapy (BT). Diagnosis and treatment of latent TB infection (LTBI) is the best strategy to prevent TB. In Rheumatic Immune-Mediated Diseases (R-IMID) and LTBI, chemoprophylaxis must be used before BT. The drugs more frequently used are Isoniazid (INH), Rifampicin (RIF) and Fluoroquinolones (FQ). These drugs may be associated with side-effects, especially hepatotoxicity. Objectives: To assess, in a single University Hospital, a ) used chemoprophylactic drugs and, b ) adverse events with these drugs. Methods: We included all consecutive patients in the last five years (2016-2020) with a diagnosis of R-IMID and a positive LTBI test (positive tuberculin skin test and/or interferon-γ–release assay), who received chemoprophylaxis prior to BT. Dose of chemoprophylactic drugs were a ) INH (5 mg/kg/d, maximum, 300 mg; for 9 months with vitamin B6), b ) RIF (10 mg/kg/d, maximum, 600 mg for 4 months) and c ) FQ levofloxacin (500 mg/day for 9 months). In all patients analytic controls that included liver enzymes were performed at the 1st and 3rd month and then at a variable time. Results: 240 patients were analyzed (165 women/ 75 men), mean age of 56±11 years. The underlying R-IMID of patients receiving chemoprophylaxis were rheumatoid arthritis (n=74, 30.8%), axial spondyloarthritis (n=59, 24.6%), psoriatic arthritis (n=62, 25.8%), conectivopathies (n=17, 7.1%), vasculitis (n=12, 5%), sarcoidosis (n=2, 0.8%), Behçet’s disease (n=1, 0.4%), inflammatory myopathies (n=1, 0.4%) and other (n=12, 5%). At the onset of chemoprophylaxis they were taking: Prednisone in 61 patients (24 of them above 10 mg/day) and the following conventional DMARD, methotrexate (n=109, 45.4%), hydroxychloroquine (n=20, 8.3%), sulfasalazine (n=11, 4.6%), leflunomide (n=4, 1.7%) and azathioprine (n=2, 0.8%). The first-line chemoprophylactic drug was INH in 232 (96.7%) patients and RIF in the remaining 8 (3.3%). Due to adverse events, second-line therapy was used in 18 (RIF, n=17 and ... |
