Anti tümör nekrozis faktör alfa tedavisinde izoniazid kemoprofilaksisinin etkinliği
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Dosyalar
Tarih
2015
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve amaç: Günümüzde immunsupresif tedavi kullanım sıklığı arttıkça bulaşıcı hastalıklar giderek önem kazanmaktadır. Bu çalışmada tümör nekrozis faktör-alfa antagonisti (anti-TNF-?) kullanan hastalarda tüberküloz sıklığını ve izoniazid (INH) profilaksisinin bu sürece etkili olup olmadığını araştırmak hedeflenmiştir. Gereç ve yöntem: Şubat 2008-Ocak 2015 tarihleri arasında romatolojik ve dermatolojik hastalıklara bağlı anti-TNF-? kullanan 23 ile 77 yaş aralığındaki 110 olgu retroprospektif olarak çalışmaya dahil edildi. Romatoloji Araştırma ve Eğitim Derneği'nin anti-TNF kullanım klavuzuna göre olgulara INH proflaksisi başlandı. Tüm hastalarda 6 ayda bir kez fizik muayene yapılıp ardından akciğer grafisi çekildi ve yılda bir kez tüberkülin deri testi (TDT) yapıldı. Bulgular: Çalışmaya alınan 110 hastada yaş ortalaması 45,1±12,1 olup %52,7 (n=58) erkekti. En sık tanı romatoid artrit (%42,7) ve ankilozan spondilit (%38,2), idi ve en sık İnfliksimab %37,3 ve Etanercept %30,9 tedavisi verilmişti. Hastaların %1,8 inde tüberküloz temas öyküsü vardı. Yıllık TDT takiplerinde başlangıca göre istatistiksel anlamlı artış gözlendi(p<0.001). TDT de 5mm sınır değer olarak kabul edildi. Başlangıçta TDT negatif olan (<5mm) hastaların %19'unda TDT konversiyonu görüldü. TDT pozitifliği erkeklerde anlamlı olarak daha yüksekti (% 74,1 ye % 48,1). TDT negatif hastalarda anti TNF- ? öncesi immunsupresif tedavi suresi daha yüksekti(p=0.033). TDT negatif grubun %42,9 una INH proflaksisi verildi. TDT pozitif olan grubun %4,4'ü INH proflaksisi almadı. İki hastada INH profilaksisini 9 ay süreyle almasına rağmen aktif tüberküloz geliştiği görüldü. Bir olguda INH ve streptomisin direnci saptanır iken hastalardan sadece birisinde INH profilaksisine bağlı karaciğer fonksiyon testi yüksekliği izlendi. Sonuç: INH profilaksisi Mtb hastalığı için mutlak koruma sağlamamaktadır. Anti TNF-? tedavisi süresince hastalar yakın takip edilmelidir. Immünsüpresif hastalarda BCG ve TDT güvenilirliği göz önüne alındığında anti-TNF ? tedavisi öncesi rutin INH proflaksisi verilmesinin tartışılması gerektiğini düşünmekteyiz.
Introduction And Aim: The incidence of tuberculosis and isoniazid (INH) prophylaxis was intended to investigate whether effective in this process of the patients who are using Tumor necrosis factor-alpha antagonist (anti- TNF-?) Materials And Methods: Between February 2008 and January 2015, 110 cases in the age range of 23 to 77 who are using anti-TNF-? depending on the disease of rheumatologic and dermatologic were included in the study retro-prospectively. According to the College of Rheumatology Research and Education Society of anti-TNF guide, INH prophylaxis was started to the patients. In all patients, physical examination done semi-annually, then chest X-ray was taken and tuberculin skin test (TST) was performed once a year. Results: In 110 patients enrolled in the study, the mean age of 45.1±12,1 and 52.7% of them (n = 58) were male. The most common diagnosis was rheumatoid arthritis (42.7%) and ankylosing spondylitis (38.2%); Infliximab 37.3% and etanercept 30.9% treatment was given most frequently. 1.8% of the patients had a history of contact with tuberculosis. Annual TST follow up from baseline was observed a statistically significant increase (p <0.001).TST was also accepted as 5 mm limit. Between the TST positive (?5mm) and negative groups, there was no significant difference in mean age (p = 0.480). TST positivity was significantly higher in males (74.1% had 48.1%). In TST negative patients, before anti-TNF, the duration of immunosuppressive therapy was higher(p=0.033).INH prophylaxis was given 42.9% of the TST-negative group. 4.4% of those with a positive TST did not take INH prophylaxis. Although INH prophylaxis in two patients developed active tuberculosis. INH and streptomycin resistance was determined in one patient. Only in the one case, LFT elevation was detected depending on the INH. Conclusion: INH prophylaxis does not provide absolute protection for Mycobacterium tuberculosis disease. During the anti-TNF-? treatment, patients should be closely follow up. In immunosuppressive patients, considering the BCG and TDT reliability, before the treatment with anti-TNF ?, we think that routine administration of INH prophylaxis should be discussed.
Introduction And Aim: The incidence of tuberculosis and isoniazid (INH) prophylaxis was intended to investigate whether effective in this process of the patients who are using Tumor necrosis factor-alpha antagonist (anti- TNF-?) Materials And Methods: Between February 2008 and January 2015, 110 cases in the age range of 23 to 77 who are using anti-TNF-? depending on the disease of rheumatologic and dermatologic were included in the study retro-prospectively. According to the College of Rheumatology Research and Education Society of anti-TNF guide, INH prophylaxis was started to the patients. In all patients, physical examination done semi-annually, then chest X-ray was taken and tuberculin skin test (TST) was performed once a year. Results: In 110 patients enrolled in the study, the mean age of 45.1±12,1 and 52.7% of them (n = 58) were male. The most common diagnosis was rheumatoid arthritis (42.7%) and ankylosing spondylitis (38.2%); Infliximab 37.3% and etanercept 30.9% treatment was given most frequently. 1.8% of the patients had a history of contact with tuberculosis. Annual TST follow up from baseline was observed a statistically significant increase (p <0.001).TST was also accepted as 5 mm limit. Between the TST positive (?5mm) and negative groups, there was no significant difference in mean age (p = 0.480). TST positivity was significantly higher in males (74.1% had 48.1%). In TST negative patients, before anti-TNF, the duration of immunosuppressive therapy was higher(p=0.033).INH prophylaxis was given 42.9% of the TST-negative group. 4.4% of those with a positive TST did not take INH prophylaxis. Although INH prophylaxis in two patients developed active tuberculosis. INH and streptomycin resistance was determined in one patient. Only in the one case, LFT elevation was detected depending on the INH. Conclusion: INH prophylaxis does not provide absolute protection for Mycobacterium tuberculosis disease. During the anti-TNF-? treatment, patients should be closely follow up. In immunosuppressive patients, considering the BCG and TDT reliability, before the treatment with anti-TNF ?, we think that routine administration of INH prophylaxis should be discussed.
Açıklama
YÖK Tez No: 394011
Anahtar Kelimeler
Göğüs Hastalıkları, Chest Diseases, Antineoplastik ajanlar, Antineoplastic agents, Profilaksi, Prophylaxis, Tüberküloz, Tuberculosis, Tümör nekroz faktörleri, Tumor necrosis factors, İsoniazid, Isoniazid
