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Introduction and Aim

OBSERVATION RESULTS OF 484 PATIENTS THAT USE TNF ALFA INHIBITOR IN RESPECT OF THE RISK OF TUBERCULOSIS. T.CAGATAY ¹ , M.AYDIN ¹ , Z.GÜLBARAN ¹ , R. YILDIZ ¹ , L. PUR ¹ , A. GÜL ² , M. INANC ² , S. KAMALI ² , B. ARTIM ² , Y. CAGATAY ² , Z. KILICASLAN ¹

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Introduction and Aim

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  1. OBSERVATION RESULTS OF 484 PATIENTS THAT USE TNF ALFA INHIBITOR IN RESPECT OF THE RISK OF TUBERCULOSIS T.CAGATAY¹, M.AYDIN¹, Z.GÜLBARAN¹, R. YILDIZ¹, L. PUR¹, A. GÜL², M. INANC², S. KAMALI², B. ARTIM², Y. CAGATAY², Z. KILICASLAN¹ Istanbul University, Faculty of Medicine Department of Pulmoner Medicine¹ Istanbul University, Faculty of Medicine Department of Rheumatology Medicine²

  2. Introduction and Aim TNF inhibitor drugs; • TNF inhibitors drugs have been using in the treatment of different rheumotologic diseases and they increases the risk of infectious illnesses, with the tuberculosis being first. • For this reason, the patients that use TNF inhibitors must followed closely. In this study the patients that use these drugs were followed and the results were eveluated.

  3. Introduction and Aim • As it is known, reactivation of Latent Microbacterial infections markedly increases the morbidity and mortality, especially in the immunesupressive individuals. • This care can create more important problems under the conditions of our country.

  4. Aim • In this study we evaluated the follow-up results for tuberculosis in patients who receive TNF Alfa Antagonists in a period of 3 years.

  5. Material And Method • Patients with various rheumatologic and dermatologic patients who receive TNF Antagonist treatment are evaluated. • 255 female • 229male of a total number of 484

  6. Method • Patients with various rheumatologic and dermatologic patients who receive TNF Antagonist treatment were evaluated. • Policlinic registrations of the patients that have come betweenAugust 2005 and February 2008 have been prepared. • Subsequent observation results have been recorded in these cards and computer.

  7. Method • PA graphy has been taken in all of the cases in the first application. • PPD skin tests with 5 TU have been applied in all of them in Tuberculosis out patient clinic • Active TB was eliminated in those with suspected lesion in PA by performing direct ARB and culture.

  8. Method • INH prophilaxis has been started for nine months in the patients whose PPD is 5 mm. and more. * • Hepatic function tests have been checked once a month. *RAED (Association for the researches and education of rheumatology)

  9. Results Caracteristics of cases

  10. Results Caracteristics of cases

  11. Results Caracteristics of cases

  12. ResultsTNF Antagonist Drugs

  13. Results Distribution of Illnesses

  14. Conclusion • At the end of this study, TB infection has been determined in 3 cases (0.6%) in our 484 patients who were followed-up for approximately 30 months • All of these cases, prophylaxis has ben recommended.One of them is not use prophylaxis • In one of them, the history of contact was positive.

  15. Conclusion • It was concluded that TNF antagonist drugs do not constitute a high risk for TB because of our wide decision to implement prophylaxis

  16. Conclusion • In our patients who are also receiving other toxic drugs besides the TNF antagonists. We have not observed hepatotoxicity (%7) by using INH for the latent infection treatment

  17. Conclusion Another important result of our study is; • That in 87 patients out of the 182 with a negative PPD test who have completed one year’s treatment , • 26 patients (29.8%)became with a positive PPD test • The test diameters were converted to 9,15 ± 0,55 from 6,60 ± 0,51 (n=182) (p= 0.001).

  18. Conclusion Therefore; • It is possible to advise to re-test the patients with PPD after one year’s TNF antagonist treatment. So INH prophylaxis must be re-evaluated

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