Emine Duygu BOZKIRLI, Müge TUFAN, Lale ÖZIŞIK, Nazan ŞEN, Ahmet YÜCEL

Anti-Tümör Nekroz Faktör Alfa Tedavisi ve Tüberkülin Cilt Testi

Giriş: Anti tümör nekroz faktör-α (anti-TNF) ilaçların kullanıma girmesi romatolojik hastalıkların tedavisi için bir dönüm noktası olmuştur. Güçlü etkilerine rağmen anti-TNF ajanların kullanımını kısıtlayan bazı faktörler vardır. Tüberküloz ve leişmanyaz gibi ülkemizde endemik olarak da gözlenebilen granülomatöz hastalıklar açısından özellikle dikkatli olunmalıdır. Ülkemizde RAED 2005 yılı Uzlaşı Toplantısı Raporu dikkate alınarak hastaların tedavi öncesi hem aktif hem de inaktif tüberküloz açısından değerlendirmeleri yapılmakta ve gereken hastalara izoniazid (INH) ile profilaksi yapılmaktadır. Materyal ve Metod: Romatoloji kliniğinde takip edilen ve anti-TNF tedavi almakta olan 43 hastanın tedavi altında tüberkülin cilt testi(TCT) testi tekrarlandı. Tedavi öncesi ilk TCT değeri, kullandıkları ilaçlar, INH profilaksi durumu, sigara kullanımı, anti-TNF ilaç kullanım süreleri değerlendirildi. Bulgular: Hastaların 14(%32.6)’ü kadın, 29(%67.4)’ü erkekti. İlk TCT ortalaması 11.72±90,3 mm (0-30) ve 2. TCT ortalaması 12.06±12.4 mm (0-45) idi. %48.8 hasta sigara kullanıyordu ve %74.4 hasta 9 ay INH profilaksisi kullanmıştı. Hastaların toplam ilaç kullanım süreleri ortalama 22.67±19.11 ay (5-68) olarak saptandı. Hastaların anti-TNF tedavi öncesindeki ilk TCT düzeyleri ile tedavi altında bakılan 2. TCT değerleri arasında istatistiksel olarak anlamlı fark (p=0.888) saptanmadı. Tartışma: Tüberküloz gerek dünyada gerekse ülkemizde hâlâ ciddi bir halk sağlığı sorunu olmaya devam etmektedir. Bu nedenle ülkemizde tedavi öncesi hastalar ayrıntılı olarak incelenmektedir. Çalışmamızda anti-TNF tedavi başlanması planlanan hastalar İlk TCT değerlerine göre değerlendirilmiş ve tedavi öncesi 32(%74.4) hastaya izoniazid profilaksisi başlanmıştır. Tedavi altındaki hastalara en erken 5 ay sonra olmak üzere kontrol TCT yapıldığında istatistiksel olarak anlamlı fark saptanmadı. Bu bulgularla anti-TNF tedavi alan hastalarda uygun izoniazid profilaksisi ile tüberküloz riskinde belirgin artış olmadığı öngörülebilir

Anahtar Kelimeler:

TNF, tüberkülin cilt testi, tüberküloz, ankilozan spondilit, romatoid artrit, spondiloartropati

Anti-Tumor Necrosis Factor Alpha Treatment and Tuberculin Skin Test

Purpose: The use of anti-tumor necrosis factor alpha (anti-TNF) drugs has been a milestone in the treatment of rheumatic diseases. Despite their strong efficacy, there are some factors restricting the use of anti-TNF agents. We must be careful especially for the granulomatous diseases which can be seen endemic in our country such as tuberculosis and leishmaniasis. In our country according to the RAED 2005 Consensus Meeting Reports, patients candidate for anti-TNF treatment are evaluated for both active and inactive tuberculosis before treatment and prophylaxis with isoniazid (INH) has been performed where indicated. Material and Methods: Tuberculin skin tests (TST) of 43 patients followed up in the Rheumatology Clinic and receiving anti-TNF therapy were repeated under treatment. Patients’ pretreatment first TST results, drugs they used, INH prophylaxis state, smoking status and the duration of anti-TNF treatment were evaluated. Results: 14 patients (32.6%) were women, while 29 (67.4%) were men. The mean of first TST values were 11.72±90.3 mm (0-30) and the mean of second TST values were 12.06±12.4 mm (0-45). 48.8% of the patients were smoking and 74.4% of the patients had received INH prophylaxis for 9 months. The mean total duration of anti-TNF drug use was found as 22.67±19.11 (5-68) months. No statistically significant difference (p=0.888) was observed between the first pretreatment and second under treatment TST results of the patients. Discussion: Tuberculosis remains to be a serious public health problem for both our country and the whole world. For this reason in our country, a detailed assessment is performed for all patients before anti-TNF treatment. In our study patients who are planned to start anti-TNF therapy were assessed with their first TST values and INH prophylaxis were given to 32 patients (74.4%) before treatment. No statistically significant difference was observed between pre and posttreatment TST values when control TST were performed with the earliest after five months of treatment. These findings may suggest that there is no evident increase in the risk of tuberculosis for patients receiving anti-TNF treatment with appropriate INH prophylaxis.

Keywords:

TNF, tuberculin skin test, tuberculosis, ankylosing spondylitis, rheumatoid arthritis, spondyloarthropathy,

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