The effectiveness of isoniazid chemoprophlaxis in anti tnf-alpha therapy

Introduction And Aim: The incidence of tuberculosis and isoniazid (INH) prophylaxis was intended to investigate whether effective in this process of the patients who are using Tumor necrosis factor-alpha antagonist (anti- TNF-α) Materials And Methods: Between February 2008 and January 2015, 110 cases in the age range of 23 to 77 who are using anti-TNF-α depending on the disease of rheumatologic and dermatologic were included in the study retro-prospectively. According to the College of Rheumatology Research and Education Society of anti-TNF guide, INH prophylaxis was started to the patients. In all patients, physical examination done semi-annually, then chest X-ray was taken and tuberculin skin test (TST) was performed once a year. Results: In 110 patients enrolled in the study, the mean age of 45.1±12,1 and 52.7% of them (n = 58) were male. The most common diagnosis was rheumatoid arthritis (42.7%) and ankylosing spondylitis (38.2%); Infliximab 37.3% and etanercept 30.9% treatment was given most frequently. 1.8% of the patients had a history of contact with tuberculosis. Annual TST follow up from baseline was observed a statistically significant increase (p <0.001).TST was also accepted as 5 mm limit. Between the TST positive (≥5mm) and negative groups, there was no significant difference in mean age (p = 0.480). TST positivity was significantly higher in males (74.1% had 48.1%). In TST negative patients, before anti-TNF, the duration of immunosuppressive therapy was higher(p=0.033).INH prophylaxis was given 42.9% of the TST-negative group. 4.4% of those with a positive TST did not take INH prophylaxis. Although INH prophylaxis in two patients developed active tuberculosis. INH and streptomycin resistance was determined in one patient. Only in the one case, LFT elevation was detected depending on the INH. Conclusion: INH prophylaxis does not provide absolute protection for Mycobacterium tuberculosis disease. During the anti-TNF-α treatment, patients should be closely follow up. In immunosuppressive patients, considering the BCG and TDT reliability, before the treatment with anti-TNF α, we think that routine administration of INH prophylaxis should be discussed.