Mycobacterial infections in patients treated with tumor necrosis factor antagonists in South Korea

Sang Kook Lee, Song Yee Kim, Eun Young Kim, Ji Ye Jung, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang, youngae kang

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: The aims of this study were to determine the incidence of tuberculosis (TB) and nontuberculous mycobacteria (NTM) lung disease in patients who were treated with tumor necrosis factor (TNF) antagonists in South Korea and to evaluate their clinical characteristics. Methods: We surveyed all patients (N = 509) who were treated with TNF antagonists at Severance Hospital, South Korea, between January 2002 and December 2011. We reviewed the patients' medical records and collected microbiological, radiographic, and clinical data, including the type of TNF blocker(s) used and the results of tuberculin skin tests and interferon-gamma release assays. Results: Rheumatoid arthritis (43.6 %) and ankylosing spondylitis (27.9 %) were the most common diseases in the patients treated with TNF antagonists. Patients received etanercept (33.4 %), infliximab (23.4 %), or adalimumab (13.2 %). The remaining patients received two or more TNF antagonists (30 %). Nine patients developed TB, and four patients developed NTM lung disease. After adjustment for age and sex, the standardized TB incidence ratio was 6.4 [95 % CI 3.1-11.7] compared with the general population. The estimated NTM incidence rate was 230.7 per 100,000 patients per year. Conclusions: Our results show that mycobacterial infections increase in patients treated with TNF antagonists. The identification of additional predictors of TB for the treatment of latent tuberculosis infection and the careful monitoring and timely diagnosis of NTM-related lung disease are needed for patients who receive long-term therapy with TNF antagonists.

Original languageEnglish
Pages (from-to)565-571
Number of pages7
JournalLung
Volume191
Issue number5
DOIs
Publication statusPublished - 2013 Oct 1

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Republic of Korea
Tumor Necrosis Factor-alpha
Infection
Nontuberculous Mycobacteria
Tuberculosis
Lung Diseases
Incidence
Interferon-gamma Release Tests
Latent Tuberculosis
Tuberculin Test
Ankylosing Spondylitis
Skin Tests
Medical Records
Rheumatoid Arthritis

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

Cite this

Lee, Sang Kook ; Kim, Song Yee ; Kim, Eun Young ; Jung, Ji Ye ; Park, Moo Suk ; Kim, Young Sam ; Kim, Se Kyu ; Chang, Joon ; kang, youngae. / Mycobacterial infections in patients treated with tumor necrosis factor antagonists in South Korea. In: Lung. 2013 ; Vol. 191, No. 5. pp. 565-571.
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title = "Mycobacterial infections in patients treated with tumor necrosis factor antagonists in South Korea",
abstract = "Background: The aims of this study were to determine the incidence of tuberculosis (TB) and nontuberculous mycobacteria (NTM) lung disease in patients who were treated with tumor necrosis factor (TNF) antagonists in South Korea and to evaluate their clinical characteristics. Methods: We surveyed all patients (N = 509) who were treated with TNF antagonists at Severance Hospital, South Korea, between January 2002 and December 2011. We reviewed the patients' medical records and collected microbiological, radiographic, and clinical data, including the type of TNF blocker(s) used and the results of tuberculin skin tests and interferon-gamma release assays. Results: Rheumatoid arthritis (43.6 {\%}) and ankylosing spondylitis (27.9 {\%}) were the most common diseases in the patients treated with TNF antagonists. Patients received etanercept (33.4 {\%}), infliximab (23.4 {\%}), or adalimumab (13.2 {\%}). The remaining patients received two or more TNF antagonists (30 {\%}). Nine patients developed TB, and four patients developed NTM lung disease. After adjustment for age and sex, the standardized TB incidence ratio was 6.4 [95 {\%} CI 3.1-11.7] compared with the general population. The estimated NTM incidence rate was 230.7 per 100,000 patients per year. Conclusions: Our results show that mycobacterial infections increase in patients treated with TNF antagonists. The identification of additional predictors of TB for the treatment of latent tuberculosis infection and the careful monitoring and timely diagnosis of NTM-related lung disease are needed for patients who receive long-term therapy with TNF antagonists.",
author = "Lee, {Sang Kook} and Kim, {Song Yee} and Kim, {Eun Young} and Jung, {Ji Ye} and Park, {Moo Suk} and Kim, {Young Sam} and Kim, {Se Kyu} and Joon Chang and youngae kang",
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Lee, SK, Kim, SY, Kim, EY, Jung, JY, Park, MS, Kim, YS, Kim, SK, Chang, J & kang, Y 2013, 'Mycobacterial infections in patients treated with tumor necrosis factor antagonists in South Korea', Lung, vol. 191, no. 5, pp. 565-571. https://doi.org/10.1007/s00408-013-9481-5

Mycobacterial infections in patients treated with tumor necrosis factor antagonists in South Korea. / Lee, Sang Kook; Kim, Song Yee; Kim, Eun Young; Jung, Ji Ye; Park, Moo Suk; Kim, Young Sam; Kim, Se Kyu; Chang, Joon; kang, youngae.

In: Lung, Vol. 191, No. 5, 01.10.2013, p. 565-571.

Research output: Contribution to journalArticle

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T1 - Mycobacterial infections in patients treated with tumor necrosis factor antagonists in South Korea

AU - Lee, Sang Kook

AU - Kim, Song Yee

AU - Kim, Eun Young

AU - Jung, Ji Ye

AU - Park, Moo Suk

AU - Kim, Young Sam

AU - Kim, Se Kyu

AU - Chang, Joon

AU - kang, youngae

PY - 2013/10/1

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N2 - Background: The aims of this study were to determine the incidence of tuberculosis (TB) and nontuberculous mycobacteria (NTM) lung disease in patients who were treated with tumor necrosis factor (TNF) antagonists in South Korea and to evaluate their clinical characteristics. Methods: We surveyed all patients (N = 509) who were treated with TNF antagonists at Severance Hospital, South Korea, between January 2002 and December 2011. We reviewed the patients' medical records and collected microbiological, radiographic, and clinical data, including the type of TNF blocker(s) used and the results of tuberculin skin tests and interferon-gamma release assays. Results: Rheumatoid arthritis (43.6 %) and ankylosing spondylitis (27.9 %) were the most common diseases in the patients treated with TNF antagonists. Patients received etanercept (33.4 %), infliximab (23.4 %), or adalimumab (13.2 %). The remaining patients received two or more TNF antagonists (30 %). Nine patients developed TB, and four patients developed NTM lung disease. After adjustment for age and sex, the standardized TB incidence ratio was 6.4 [95 % CI 3.1-11.7] compared with the general population. The estimated NTM incidence rate was 230.7 per 100,000 patients per year. Conclusions: Our results show that mycobacterial infections increase in patients treated with TNF antagonists. The identification of additional predictors of TB for the treatment of latent tuberculosis infection and the careful monitoring and timely diagnosis of NTM-related lung disease are needed for patients who receive long-term therapy with TNF antagonists.

AB - Background: The aims of this study were to determine the incidence of tuberculosis (TB) and nontuberculous mycobacteria (NTM) lung disease in patients who were treated with tumor necrosis factor (TNF) antagonists in South Korea and to evaluate their clinical characteristics. Methods: We surveyed all patients (N = 509) who were treated with TNF antagonists at Severance Hospital, South Korea, between January 2002 and December 2011. We reviewed the patients' medical records and collected microbiological, radiographic, and clinical data, including the type of TNF blocker(s) used and the results of tuberculin skin tests and interferon-gamma release assays. Results: Rheumatoid arthritis (43.6 %) and ankylosing spondylitis (27.9 %) were the most common diseases in the patients treated with TNF antagonists. Patients received etanercept (33.4 %), infliximab (23.4 %), or adalimumab (13.2 %). The remaining patients received two or more TNF antagonists (30 %). Nine patients developed TB, and four patients developed NTM lung disease. After adjustment for age and sex, the standardized TB incidence ratio was 6.4 [95 % CI 3.1-11.7] compared with the general population. The estimated NTM incidence rate was 230.7 per 100,000 patients per year. Conclusions: Our results show that mycobacterial infections increase in patients treated with TNF antagonists. The identification of additional predictors of TB for the treatment of latent tuberculosis infection and the careful monitoring and timely diagnosis of NTM-related lung disease are needed for patients who receive long-term therapy with TNF antagonists.

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