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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  ;  Young Ae Kang 
 LUNG, Vol.191(5) : 565-571, 2013 
Journal Title
Issue Date
Adalimumab ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal/adverse effects ; Antibodies, Monoclonal/therapeutic use ; Antibodies, Monoclonal, Humanized/adverse effects ; Antibodies, Monoclonal, Humanized/therapeutic use ; Antirheumatic Agents/adverse effects* ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/drug therapy* ; Cohort Studies ; Etanercept ; Female ; Humans ; Immunoglobulin G/adverse effects ; Immunoglobulin G/therapeutic use ; Incidence ; Infliximab ; Longitudinal Studies ; Male ; Middle Aged ; Mycobacterium Infections/epidemiology* ; Mycobacterium Infections, Nontuberculous/epidemiology ; Receptors, Tumor Necrosis Factor/therapeutic use ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Spondylitis, Ankylosing/drug therapy* ; Tuberculosis/epidemiology ; Tumor Necrosis Factor-alpha/antagonists & inhibitors* ; Young Adult
Mycobacterium tuberculosis ; Nontuberculous mycobacterium ; Tumor necrosis factor antagonist
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Young Ae(강영애) ORCID logo https://orcid.org/0000-0002-7783-5271
Kim, Se Kyu(김세규)
Kim, Song Yee(김송이) ORCID logo https://orcid.org/0000-0001-8627-486X
Kim, Young Sam(김영삼) ORCID logo https://orcid.org/0000-0001-9656-8482
Kim, Eun Young(김은영) ORCID logo https://orcid.org/0000-0002-3281-5744
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Lee, Sang Kook(이상국)
Chang, Joon(장준) ORCID logo https://orcid.org/0000-0003-4542-6841
Jung, Ji Ye(정지예) ORCID logo https://orcid.org/0000-0003-1589-4142
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