RT Journal Article
T1 Tuberculosis Disease in Children and Adolescents on Therapy With Antitumor Necrosis Factor-ɑ Agents: A Collaborative, Multicenter Paediatric Tuberculosis Network European Trials Group (ptbnet) Study.
A1 Noguera-Julian, Antoni
A1 Calzada-Hernández, Joan
A1 Brinkmann, Folke
A1 Basu Roy, Robindra
A1 Bilogortseva, Olga
A1 Buettcher, Michael
A1 Carvalho, Isabel
A1 Chechenyeva, Vira
A1 Falcón, Lola
A1 Goetzinger, Florian
A1 Guerrero-Laleona, Carmelo
A1 Hoffmann, Peter
A1 Jelusic, Marija
A1 Niehues, Tim
A1 Ozere, Iveta
A1 Shackley, Fiona
A1 Suciliene, Elena
A1 Welch, Steven B
A1 Schölvinck, Elisabeth H
A1 Ritz, Nicole
A1 Tebruegge, Marc
K1 anti–TNF-alpha
K1 children
K1 miliary tuberculosis
K1 reactivation
K1 tuberculosis
AB In adults, anti-tumor necrosis factor-α (TNF-α) therapy is associated with progression of latent tuberculosis (TB) infection (LTBI) to TB disease, but pediatric data are limited. Retrospective multicenter study within the Paediatric Tuberculosis Network European Trials Group, capturing patients  Sixty-six tertiary healthcare institutions providing care for children with TB participated. Nineteen cases were identified: Crohn's disease (n = 8; 42%) and juvenile idiopathic arthritis (n = 6; 32%) were the commonest underlying conditions. Immune-based TB screening (tuberculin skin test and/or interferon-γ release assay) was performed in 15 patients before commencing anti-TNF-α therapy but only identified 1 LTBI case; 13 patients were already receiving immunosuppressants at the time of screening. The median interval between starting anti-TNF-α therapy and TB diagnosis was 13.1 (IQR, 7.1-20.3) months. All cases presented with severe disease, predominantly miliary TB (n = 14; 78%). One case was diagnosed postmortem. TB was microbiologically confirmed in 15 cases (79%). The median duration of anti-TB treatment was 50 (IQR, 46-66) weeks. Five of 15 (33%) cases who had completed TB treatment had long-term sequelae. LTBI screening is frequently false-negative in this patient population, likely due to immunosuppressants impairing test performance. Therefore, patients with immune-mediated diseases should be screened for LTBI at the point of diagnosis, before commencing immunosuppressive medication. Children on anti-TNF-α therapy are prone to severe TB disease and significant long-term morbidity. Those observations underscore the need for robust LTBI screening programs in this high-risk patient population, even in low-TB-prevalence settings.
YR 2020
FD 2020
LK http://hdl.handle.net/10668/14783
UL http://hdl.handle.net/10668/14783
LA en
DS RISalud
RD Apr 6, 2025