Highlights
- •MG patients on immune therapy are not at higher risk of developing tuberculosis.
- •Consider tuberculosis preventative therapy when higher prednisone doses are used.
- •Consider tuberculosis preventative therapy in those with scarring on chest X-ray.
Abstract
Data regarding the risk of tuberculosis (TB) in myasthenia gravis (MG) patients receiving
immunosuppressive therapy is limited, and the benefit of TB preventative therapy in
these patients is uncertain. We audited observational data collected at an MG clinic
in South Africa over a ~ 10-year period, of cases who received immunosuppressive therapy.
The total time that the cohort was at risk (patient-years) was used as the denominator
to calculate TB incidence after immunosuppressive therapy initiation. Multivariate
logistic regression analysis was performed to identify differences between patients
who did, and those who did not, develop TB. Of 480 cases, only two received TB preventative
therapy when starting immunotherapy. Seventeen of 282 (6%) patients tested, were HIV-infected.
With a median follow-up of 3.6 years (interquartile range 1;7.5), 13 (3%) patients
(all HIV-uninfected) developed TB (38% within 12 months of starting immunosuppressive
therapy). The incidence rate of TB in the study population (≤401/100000 person-years)
was not higher than that for the hospital's catchment area during the same period
(>500/100000 population). The maximum dose of prescribed prednisone was higher in
patients who developed TB compared to those who did not (median: 0.6 mg/kg/day vs
0.4; 0.002); Odds ratio for TB increased 1.26-fold for every 0.1 mg/kg/day increase
in maximum dose (p = 0.001). In our TB endemic setting, receiving immunosuppressive therapy was not
associated with excess TB in MG patients. Preventative therapy may be considered in
those who are at greatest risk of developing TB and receiving high-dose prednisone.
Keywords
Abbreviations:
TB (tuberculosis), PT (preventative therapy), MG (myasthenia gravis), HIV (human immune deficiency virus), PET-CT (positron emission tomography-computerized tomography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 13, 2021
Accepted:
April 9,
2021
Received in revised form:
March 21,
2021
Received:
February 20,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
