Background and aims: Use of anti-TNF agents increases the risk of TB, especially in Asian countries. The guideline suggested that the treatment of latent TB infection (LTBI) is recommended with oral isoniazid (INH) nine months and used TNF-α antagonist four weeks after treatment. However, the TB infection prevention by using TNF-α antagonist remains unclear in Taiwan. We evaluated the adherence rates of patients received anti -TNF agents with latent tuberculosis infection (LTBI) prophylaxis treatment.
Methods: Retrospectively collected the medical records of outpatient received adalimumab from Jan. 2014 to Dec. 2015. Brio Query version 6 as a computer program to collect patient information
Results: There are 49 patients included in this study. Eighteen percent (9/49) of the patients received LTBI prophylaxis. Seventy eight percent (7/9) patients were found of positive QuantiFERON test, and 22% (2/9) revealed intermediate results. One of the patient with Anti-HBc (+) and HCV (+) ceased treatment four months later. He was found of ALT level increase to 98 IU/L while taking INH again in the first month. The liver function returned to normal after INH discontinuation. The other 89% (8/9) completed 9 months treatment course. One of them is hepatitis B carrier with liver function impairment after taking medicine for six months. This individual case was done in closely monitored by doctor, and hepatic function return to normal three months after treatment.
Conclusion: This study shows the risk of INH-induced liver function impairment is higher than the other country. The QuantiFERON testing are highly recommend if patients taking TNF-α inhibitor and another therapy instead seems to be more in line with prophylaxis for tuberculosis in Taiwan.
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