Tuberculosis in children and adolescents with rheumatic diseases using biologic agents: an integrative review

Author:

Lima Lenita de Melo1ORCID,Aurilio Rafaela Baroni1ORCID,Fonseca Adriana Rodrigues2ORCID,Parente Ana Alice Amaral Ibiapina1ORCID,Sant’Anna Maria de Fátima Bazhuni Pombo1ORCID,Sant’Anna Clemax Couto1ORCID

Affiliation:

1. Instituto de Puericultura e Pediatria Martagão Gesteira, Brazil

2. Instituto de Puericultura e Pediatria Martagão Gesteira, Brazil; Universidade Federal do Rio de Janeiro, Brazil

Abstract

ABSTRACT Objective: To conduct a bibliographic review on tuberculosis (TB) disease in children and adolescents with rheumatic diseases, being managed with biologic therapy. Data source: An integrative review with a search in the U.S. National Library of Medicine and the National Institutes of Health (PubMed) using the following descriptors and Boolean operators: ([“tuberculosis”] AND ([“children”] OR [“adolescent”]) AND [“rheumatic diseases”] AND ([“tumor necrosis factor-alpha”] OR [“etanercept”] OR [“adalimumab”] OR [“infliximab”] OR [“biological drugs”] OR [“rituximab”] OR [“belimumab”] OR [“tocilizumab”] OR [“canakinumab”] OR [“golimumab”] OR [“secukinumab”] OR [“ustekinumab”] OR [“tofacitinib”] OR [“baricitinib”] OR [“anakinra”] OR [“rilonacept”] OR [“abatacept”]), between January 2010 and October 2021. Data synthesis: Thirty-seven articles were included, with the total number of 36,198 patients. There were 81 cases of latent tuberculosis infection (LTBI), 80 cases of pulmonary tuberculosis (PTB), and four of extrapulmonary tuberculosis (EPTB). The main rheumatic disease was juvenile idiopathic arthritis. Among LTBI cases, most were diagnosed at screening and none progressed to TB disease during follow-up. Of the TB cases using biologics, most used tumor necrosis factor-alpha inhibitors (anti-TNFα) drugs. There was only one death. Conclusions: The study revealed a low rate of active TB in pediatric patients using biologic therapy. Screening for LTBI before initiating biologics should be done in all patients, and treatment, in cases of positive screening, plays a critical role in preventing progression to TB disease.

Publisher

FapUNIFESP (SciELO)

Subject

Pediatrics, Perinatology and Child Health

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