Incidência de tuberculose em pacientes com artrite reumatoide em uso de bloqueadores do TNF no Brasil: dados do Registro Brasileiro ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017

AUTHORS

Claudia Leiko Yonekura, Rene Donizeti Ribeiro Oliveira, David C. Titton, Roberto Ranza, Aline Ranzolin, André L. Hayata, Ângela Duarte, Inês G. Silveira, Hellen M. da S. de Carvalho, Júlio C. Bertacini de Moraes, Mirhelen Mendes de Abreu, Valéria Valim, Washington Bianchi, Claiton Viegas Brenol, Ivanio A. Pereira, Izaias Costa, José C. Macieira, José R.S. Miranda, Luiz S. Guedes-Barbosa, Manoel B. Bertolo, Maria Fátima Lobato da C. Sauma, Marília B.G. Silva, Marlene Freire, Morton A. Scheinberg, Roberto A. Toledo, Sheila K.F. Oliveira, Vander Fernandes, Marcelo M. Pinheiro, Glaucio Castro, Walber Pinto Vieira, Cesar Emile Baaklini, Antonio Ruffino-Netto, Geraldo da Rocha Castelar Pinheiro, Ieda Maria Magalhães Laurindo, Paulo Louzada-Junior

ABSTRACT

ResumoObjetivosAvaliar incidência de tuberculose e triagem para tuberculose latente em brasileiros com artrite reumatoide em uso de agentes biológicos na prática clinica.Pacientes e métodosEstudo de coorte com dados do Registro Brasileiro de Monitoração de Terapias Biológicas (BiobadaBrasil), de 01/2009 a 05/2013, abrangeu 1.552 tratamentos, 415 somente com drogas modificadoras do curso da doença (MMCDs) sintéticas, 942 MMCDs sintéticas em associação com anti‐TNF (etanercepte, infliximabe, adalimumabe) e 195 MMCDs sintéticas em associação com outros biológicos (abatacepte, rituximabe e tocilizumabe). Avaliaram‐se ocorrência de tuberculose, tempo de exposição às drogas e triagem para TB. Análise estatística: teste t não pareado e teste de Fisher bicaudal; p<0,05.ResultadosO tempo de exposição dos controles foi de 981 pacientes‐ano, do grupo de anti‐TNF foi de 1.744 pacientes‐ano (adalimumabe=676, infliximabe=547 e etanercepte=521 pacientes‐ano) e o de outros biológicos de 336 pacientes‐ano. A incidência de TB foi de 1,01/1.000 pacientes‐ano nos controles e de 2,87 pacientes‐ano nos usuários de anti‐TNF (adalimumabe=4,43/1.000 pacientes‐ano; etanercepte=1,92/1.000 pacientes‐ano e infliximabe=1,82/1.000 pacientes‐ano). Não houve casos de tuberculose no grupo de outros biológicos. O tempo médio de exposição até a ocorrência de tuberculose foi de 27(11) meses para o grupo anti‐TNF.ConclusõesA incidência de tuberculose foi maior nos usuários de MMCDs sintéticas e anti‐TNF do que nos usuários de MMCDs sintéticas e de MMCDs sintéticas e biológicos não anti‐TNF, e também mais tardia, sugerindo infecção durante o tratamento, e não falha na triagem.AbstractObjectivesTo assess the incidence of tuberculosis and to screen for latent tuberculosis infection among Brazilians with rheumatoid arthritis using biologics in clinical practice.Patients and methodsThis cohort study used data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas–BiobadaBrasil), from 01/2009 to 05/2013, encompassing 1,552 treatments, including 415 with only synthetic disease‐modifying anti‐rheumatic drugs, 942 synthetic DMARDs combined with anti‐tumor necrosis factor (etanercept, infliximab, adalimumab) and 195 synthetic DMARDs combined with other biologics (abatacept, rituximab and tocilizumab). The occurrence of tuberculosis and the drug exposure time were assessed, and screening for tuberculosis was performed. Statistical analysis: Unpaired t‐test and Fisher's two‐tailed test; p<0.05.ResultsThe exposure times were 981 patient‐years in the controls, 1744 patient‐years in the anti‐TNF group (adalimumab=676, infliximab=547 and etanercept=521 patient‐years) and 336 patient‐years in the other biologics group. The incidence rates of tuberculosis were 1.01/1,000 patient‐years in the controls and 2.87 patient‐years among anti‐TNF users (adalimumab=4.43/1,000 patient‐years; etanercept=1.92/1,000 patient‐years and infliximab=1.82/1,000 patient‐years). No cases of tuberculosis occurred in the other biologics group. The mean drug exposure time until the occurrence of TB was 27(11) months for the anti‐TNF group.ConclusionsThe incidence of tuberculosis was higher among users of synthetic DMARDs and anti‐TNF than among users of synthetic DMARDs and synthetic DMARDs and non‐anti‐TNF biologics and also occurred later, suggesting infection during treatment and no screening failure More... »

PAGES

477-483

Identifiers

URI

http://scigraph.springernature.com/pub.10.1016/j.rbr.2017.05.003

DOI

http://dx.doi.org/10.1016/j.rbr.2017.05.003

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1090285246


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    "description": "ResumoObjetivosAvaliar incid\u00eancia de tuberculose e triagem para tuberculose latente em brasileiros com artrite reumatoide em uso de agentes biol\u00f3gicos na pr\u00e1tica clinica.Pacientes e m\u00e9todosEstudo de coorte com dados do Registro Brasileiro de Monitora\u00e7\u00e3o de Terapias Biol\u00f3gicas (BiobadaBrasil), de 01/2009 a 05/2013, abrangeu 1.552 tratamentos, 415 somente com drogas modificadoras do curso da doen\u00e7a (MMCDs) sint\u00e9ticas, 942 MMCDs sint\u00e9ticas em associa\u00e7\u00e3o com anti\u2010TNF (etanercepte, infliximabe, adalimumabe) e 195 MMCDs sint\u00e9ticas em associa\u00e7\u00e3o com outros biol\u00f3gicos (abatacepte, rituximabe e tocilizumabe). Avaliaram\u2010se ocorr\u00eancia de tuberculose, tempo de exposi\u00e7\u00e3o \u00e0s drogas e triagem para TB. An\u00e1lise estat\u00edstica: teste t n\u00e3o pareado e teste de Fisher bicaudal; p<0,05.ResultadosO tempo de exposi\u00e7\u00e3o dos controles foi de 981 pacientes\u2010ano, do grupo de anti\u2010TNF foi de 1.744 pacientes\u2010ano (adalimumabe=676, infliximabe=547 e etanercepte=521 pacientes\u2010ano) e o de outros biol\u00f3gicos de 336 pacientes\u2010ano. A incid\u00eancia de TB foi de 1,01/1.000 pacientes\u2010ano nos controles e de 2,87 pacientes\u2010ano nos usu\u00e1rios de anti\u2010TNF (adalimumabe=4,43/1.000 pacientes\u2010ano; etanercepte=1,92/1.000 pacientes\u2010ano e infliximabe=1,82/1.000 pacientes\u2010ano). N\u00e3o houve casos de tuberculose no grupo de outros biol\u00f3gicos. O tempo m\u00e9dio de exposi\u00e7\u00e3o at\u00e9 a ocorr\u00eancia de tuberculose foi de 27(11) meses para o grupo anti\u2010TNF.Conclus\u00f5esA incid\u00eancia de tuberculose foi maior nos usu\u00e1rios de MMCDs sint\u00e9ticas e anti\u2010TNF do que nos usu\u00e1rios de MMCDs sint\u00e9ticas e de MMCDs sint\u00e9ticas e biol\u00f3gicos n\u00e3o anti\u2010TNF, e tamb\u00e9m mais tardia, sugerindo infec\u00e7\u00e3o durante o tratamento, e n\u00e3o falha na triagem.AbstractObjectivesTo assess the incidence of tuberculosis and to screen for latent tuberculosis infection among Brazilians with rheumatoid arthritis using biologics in clinical practice.Patients and methodsThis cohort study used data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitora\u00e7\u00e3o de Terapias Biol\u00f3gicas\u2013BiobadaBrasil), from 01/2009 to 05/2013, encompassing 1,552 treatments, including 415 with only synthetic disease\u2010modifying anti\u2010rheumatic drugs, 942 synthetic DMARDs combined with anti\u2010tumor necrosis factor (etanercept, infliximab, adalimumab) and 195 synthetic DMARDs combined with other biologics (abatacept, rituximab and tocilizumab). The occurrence of tuberculosis and the drug exposure time were assessed, and screening for tuberculosis was performed. Statistical analysis: Unpaired t\u2010test and Fisher's two\u2010tailed test; p<0.05.ResultsThe exposure times were 981 patient\u2010years in the controls, 1744 patient\u2010years in the anti\u2010TNF group (adalimumab=676, infliximab=547 and etanercept=521 patient\u2010years) and 336 patient\u2010years in the other biologics group. The incidence rates of tuberculosis were 1.01/1,000 patient\u2010years in the controls and 2.87 patient\u2010years among anti\u2010TNF users (adalimumab=4.43/1,000 patient\u2010years; etanercept=1.92/1,000 patient\u2010years and infliximab=1.82/1,000 patient\u2010years). No cases of tuberculosis occurred in the other biologics group. The mean drug exposure time until the occurrence of TB was 27(11) months for the anti\u2010TNF group.ConclusionsThe incidence of tuberculosis was higher among users of synthetic DMARDs and anti\u2010TNF than among users of synthetic DMARDs and synthetic DMARDs and non\u2010anti\u2010TNF biologics and also occurred later, suggesting infection during treatment and no screening failure", 
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34 schema:description ResumoObjetivosAvaliar incidência de tuberculose e triagem para tuberculose latente em brasileiros com artrite reumatoide em uso de agentes biológicos na prática clinica.Pacientes e métodosEstudo de coorte com dados do Registro Brasileiro de Monitoração de Terapias Biológicas (BiobadaBrasil), de 01/2009 a 05/2013, abrangeu 1.552 tratamentos, 415 somente com drogas modificadoras do curso da doença (MMCDs) sintéticas, 942 MMCDs sintéticas em associação com anti‐TNF (etanercepte, infliximabe, adalimumabe) e 195 MMCDs sintéticas em associação com outros biológicos (abatacepte, rituximabe e tocilizumabe). Avaliaram‐se ocorrência de tuberculose, tempo de exposição às drogas e triagem para TB. Análise estatística: teste t não pareado e teste de Fisher bicaudal; p<0,05.ResultadosO tempo de exposição dos controles foi de 981 pacientes‐ano, do grupo de anti‐TNF foi de 1.744 pacientes‐ano (adalimumabe=676, infliximabe=547 e etanercepte=521 pacientes‐ano) e o de outros biológicos de 336 pacientes‐ano. A incidência de TB foi de 1,01/1.000 pacientes‐ano nos controles e de 2,87 pacientes‐ano nos usuários de anti‐TNF (adalimumabe=4,43/1.000 pacientes‐ano; etanercepte=1,92/1.000 pacientes‐ano e infliximabe=1,82/1.000 pacientes‐ano). Não houve casos de tuberculose no grupo de outros biológicos. O tempo médio de exposição até a ocorrência de tuberculose foi de 27(11) meses para o grupo anti‐TNF.ConclusõesA incidência de tuberculose foi maior nos usuários de MMCDs sintéticas e anti‐TNF do que nos usuários de MMCDs sintéticas e de MMCDs sintéticas e biológicos não anti‐TNF, e também mais tardia, sugerindo infecção durante o tratamento, e não falha na triagem.AbstractObjectivesTo assess the incidence of tuberculosis and to screen for latent tuberculosis infection among Brazilians with rheumatoid arthritis using biologics in clinical practice.Patients and methodsThis cohort study used data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas–BiobadaBrasil), from 01/2009 to 05/2013, encompassing 1,552 treatments, including 415 with only synthetic disease‐modifying anti‐rheumatic drugs, 942 synthetic DMARDs combined with anti‐tumor necrosis factor (etanercept, infliximab, adalimumab) and 195 synthetic DMARDs combined with other biologics (abatacept, rituximab and tocilizumab). The occurrence of tuberculosis and the drug exposure time were assessed, and screening for tuberculosis was performed. Statistical analysis: Unpaired t‐test and Fisher's two‐tailed test; p<0.05.ResultsThe exposure times were 981 patient‐years in the controls, 1744 patient‐years in the anti‐TNF group (adalimumab=676, infliximab=547 and etanercept=521 patient‐years) and 336 patient‐years in the other biologics group. The incidence rates of tuberculosis were 1.01/1,000 patient‐years in the controls and 2.87 patient‐years among anti‐TNF users (adalimumab=4.43/1,000 patient‐years; etanercept=1.92/1,000 patient‐years and infliximab=1.82/1,000 patient‐years). No cases of tuberculosis occurred in the other biologics group. The mean drug exposure time until the occurrence of TB was 27(11) months for the anti‐TNF group.ConclusionsThe incidence of tuberculosis was higher among users of synthetic DMARDs and anti‐TNF than among users of synthetic DMARDs and synthetic DMARDs and non‐anti‐TNF biologics and also occurred later, suggesting infection during treatment and no screening failure
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