E142 Tuberculosis risk under TNF inhibitors: limitations of pre-treatment screening and chemoprophylaxis in four spondyloarthritis cases

Abstract Background/Aims Although TNF inhibitors have a generally favorable safety profile in the management of spondyloarthritis, the risk of tuberculosis is well established. In practice, systematic screening for latent tuberculosis and chemoprophylaxis, though both recommended in pre-treatment screening, do not provide complete protection against tuberculosis reactivation or the onset of de novo tuberculosis. Methods We report four cases of patients with spondyloarthritis treated with TNFα inhibitors who, despite undergoing systematic screening for latent tuberculosis and receiving chemoprophylaxis, developed tuberculosis during treatment. Results This series consists of four male patients with a mean age of 33.5 years. Three of them had an initial negative pre-treatment screening (QuantiFERON and chest X-ray), while one patient tested positive on QuantiFERON and had received chemoprophylaxis for two months before starting the TNF inhibitor. The biologic agents administered were adalimumab in three cases and Infliximab in one. The interval between the initiation of biologic therapy and the onset of tuberculosis ranged from 2 to 36 months, including one case that occurred five months after biotherapy discontinuation. The reported cases included multifocal tuberculosis, pulmonary tuberculosis, and two cases of pleuropulmonary and lymph node tuberculosis. Diagnosis was based on imaging and the detection of Mycobacterium tuberculosis by GenXpert or PCR. Biologic therapy was discontinued for all four patients. All received anti-bacillary treatment, with two making a full recovery. In these two cases, anti-TNF therapy was resumed with etanercept and golimumab as alternative therapies. Conclusion The risk of tuberculosis in patients with spondyloarthritis treated with TNF inhibitors remains significant despite screening and chemoprophylaxis recommendations, and may even occur after treatment discontinuation. Whether it is a reactivation of latent infection or de novo forms, vigilance is essential, especially in endemic regions. More rigorous screening strategies or extended prophylaxis in at-risk patients should be considered. Disclosure S. Benlalah: None. K. Nassar: None. A. Ajerouassi: None. S. Zaher: None. W. Rachidi: None. S. Janani: None.