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

• Published in: Revista Paulista de Pediatria Vol. 42; p. e2022084
• Main Authors: Lima, Lenita de Melo, Aurilio, Rafaela Baroni, Fonseca, Adriana Rodrigues, Parente, Ana Alice Amaral Ibiapina, Sant'Anna, Maria de Fátima Bazhuni Pombo, Sant'Anna, Clemax Couto
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade de Pediatria de São Paulo 2023
• Subjects: Adolescent; Adolescents; Antirheumatic Agents - therapeutic use; Biologic agents; Biological Factors - therapeutic use; Biological Products; Child; Children; Humans; Latent tuberculosis; Latent Tuberculosis - diagnosis; Latent Tuberculosis - drug therapy; Latent Tuberculosis - epidemiology; Review; Rheumatic diseases; Rheumatic Diseases - drug therapy; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tumor Necrosis Factors - therapeutic use; United States; United States
• ISSN: 0103-0582; 1984-0462
• DOI: 10.1590/1984-0462/2024/42/2022084

To conduct a bibliographic review on tuberculosis (TB) disease in children and adolescents with rheumatic diseases, being managed with biologic therapy.
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.
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.
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.