Abstract：
BACKGROUND: Tuberculosis (TB) is a common complication associated with treatment with tumour necrosis factor (TNF) antagonists and Janus kinase (JAK) inhibitors. However, there is uncertainty about the risk of TB relapse in patients with TB and comorbidities requiring treatment with these agents.
OBJECTIVE: To assess the risk of TB relapse in patients (re-)started on TNF antagonists or JAK inhibitors.
METHODS: Systematic review.
METHODS: PubMed and Cochrane Library databases until 11 December 2023.
METHODS: Randomized control trials, prospective and retrospective cohort studies, case reports and case series.
METHODS: Patients with current or previous TB who were (re-)started on TNF antagonists or JAK inhibitors.
METHODS: (Re-)introduction of TNF antagonists and JAK inhibitors.
UNASSIGNED: All studies meeting entry criteria were included regardless of quality.
UNASSIGNED: Categorical data are presented as frequencies and percentages. For non-normally distributed aggregated data, we calculated the pooled weighted median with 95% CI. For individual patient data, the median and interquartile range (IQR) were calculated.
RESULTS: Of 5018 articles screened for eligibility, 67 publications reporting on 368 TB patients who (re-)initiated treatment with TNF antagonists for underlying diseases were included. The median age was 42.5 years (95% CI: 40.4-42.5) and the proportion of female patients was 36.6% (n = 74) of patients whose sex was reported. A total of 14 patients (3.8%, 95% CI: 2.1-6.3%) developed TB relapse after a median of 8.5 months (interquartile range, 6.8-14.8 months) following (re-)initiation of anti-TNF treatment. Furthermore, among 251 articles screened for eligibility, 11 reports on TB patients who were (re-)started on JAK inhibitors for underlying diseases were identified. The median age was 62 years (interquartile range, 48.5-68.5 years) and 45.5% (n = 5) were female. Only one patient (9.1%; 95% CI: 0.2-41.3%) had TB reactivation 10 months after starting treatment with ruxolitinib. In addition, 94 patients who were treated with TNF antagonists and two patients temporarily treated with JAK inhibitors for the prevention or treatment of paradoxical reactions were analysed. None of the publications reported microbiological failure or worsening of TB-related symptoms.
CONCLUSIONS: (Re-)initiation of TNF antagonists and JAK inhibitors may be relatively safe in patients with current or previous TB and the need for further treatment of underlying diseases.
OBJECTIVE: To assess the risk of TB relapse in patients (re-)started on TNF antagonists or JAK inhibitors.
METHODS: Systematic review.
METHODS: PubMed and Cochrane Library databases until 11 December 2023.
METHODS: Randomized control trials, prospective and retrospective cohort studies, case reports and case series.
METHODS: Patients with current or previous TB who were (re-)started on TNF antagonists or JAK inhibitors.
METHODS: (Re-)introduction of TNF antagonists and JAK inhibitors.
UNASSIGNED: All studies meeting entry criteria were included regardless of quality.
UNASSIGNED: Categorical data are presented as frequencies and percentages. For non-normally distributed aggregated data, we calculated the pooled weighted median with 95% CI. For individual patient data, the median and interquartile range (IQR) were calculated.
RESULTS: Of 5018 articles screened for eligibility, 67 publications reporting on 368 TB patients who (re-)initiated treatment with TNF antagonists for underlying diseases were included. The median age was 42.5 years (95% CI: 40.4-42.5) and the proportion of female patients was 36.6% (n = 74) of patients whose sex was reported. A total of 14 patients (3.8%, 95% CI: 2.1-6.3%) developed TB relapse after a median of 8.5 months (interquartile range, 6.8-14.8 months) following (re-)initiation of anti-TNF treatment. Furthermore, among 251 articles screened for eligibility, 11 reports on TB patients who were (re-)started on JAK inhibitors for underlying diseases were identified. The median age was 62 years (interquartile range, 48.5-68.5 years) and 45.5% (n = 5) were female. Only one patient (9.1%; 95% CI: 0.2-41.3%) had TB reactivation 10 months after starting treatment with ruxolitinib. In addition, 94 patients who were treated with TNF antagonists and two patients temporarily treated with JAK inhibitors for the prevention or treatment of paradoxical reactions were analysed. None of the publications reported microbiological failure or worsening of TB-related symptoms.
CONCLUSIONS: (Re-)initiation of TNF antagonists and JAK inhibitors may be relatively safe in patients with current or previous TB and the need for further treatment of underlying diseases.
摘要：
背景：结核病（TB）是与使用肿瘤坏死因子（TNF）拮抗剂和Janus激酶（JAK）抑制剂治疗相关的常见并发症。然而,对于需要使用这些药物治疗的结核病和合并症患者,结核病复发风险存在不确定性.
目标：合作伙伴网站Hamburg-Lübeck-Borstel-Riems。评估开始使用TNF拮抗剂或JAK抑制剂的患者（再）结核病复发的风险。
方法：系统评价。
方法：PubMed和CochraneLibrary数据库，直至2023年12月11日。
方法：研究报告了当前或先前的TB患者（重新）开始使用TNF拮抗剂或JAK抑制剂。
结果：在筛选合格的5018篇文章中，纳入了67份出版物，报告了368例（重新）开始使用TNF拮抗剂治疗基础疾病的TB患者。中位年龄为42.5岁（95CI：40.4-42.5），女性患者的比例为36.6%（n=74）。共有14名患者(3.8%,95％CI：2.1-6.3％）在（重新）开始抗TNF治疗后的中位8.5个月（IQR：6.8-14.8个月）后出现结核病复发。此外，在251篇筛选合格的文章中，确定了11份关于(重新)开始使用JAK抑制剂治疗基础疾病的结核病患者的报告。中位年龄为62岁（IQR：48.5-68.5岁），45.5%（n=5）为女性。只有一名患者(9.1%，95％CI：0.2-41.3％）在开始用鲁索利替尼治疗10个月后出现TB再激活。此外,分析了94例接受TNF拮抗剂治疗的患者和两名暂时接受JAK抑制剂治疗的患者，以预防或治疗反常反应。没有一篇出版物报道微生物失效或结核病相关症状恶化。
结论：（重新）启动TNF拮抗剂和JAK抑制剂在当前或先前的TB患者中可能相对安全，并且需要进一步治疗基础疾病。
目标：合作伙伴网站Hamburg-Lübeck-Borstel-Riems。评估开始使用TNF拮抗剂或JAK抑制剂的患者（再）结核病复发的风险。
方法：系统评价。
方法：PubMed和CochraneLibrary数据库，直至2023年12月11日。
方法：研究报告了当前或先前的TB患者（重新）开始使用TNF拮抗剂或JAK抑制剂。
结果：在筛选合格的5018篇文章中，纳入了67份出版物，报告了368例（重新）开始使用TNF拮抗剂治疗基础疾病的TB患者。中位年龄为42.5岁（95CI：40.4-42.5），女性患者的比例为36.6%（n=74）。共有14名患者(3.8%,95％CI：2.1-6.3％）在（重新）开始抗TNF治疗后的中位8.5个月（IQR：6.8-14.8个月）后出现结核病复发。此外，在251篇筛选合格的文章中，确定了11份关于(重新)开始使用JAK抑制剂治疗基础疾病的结核病患者的报告。中位年龄为62岁（IQR：48.5-68.5岁），45.5%（n=5）为女性。只有一名患者(9.1%，95％CI：0.2-41.3％）在开始用鲁索利替尼治疗10个月后出现TB再激活。此外,分析了94例接受TNF拮抗剂治疗的患者和两名暂时接受JAK抑制剂治疗的患者，以预防或治疗反常反应。没有一篇出版物报道微生物失效或结核病相关症状恶化。
结论：（重新）启动TNF拮抗剂和JAK抑制剂在当前或先前的TB患者中可能相对安全，并且需要进一步治疗基础疾病。
