Tuberculosis preventive treatment may reduce the risk of tuberculosis in patients with rheumatic diseases, according to a recent study.
In the systematic review and meta-analysis, published in eClinicalMedicine, investigators examined the data from 64 studies involving 116,015 patients worldwide. They found that tuberculosis preventive treatment (TPT) lowered tuberculosis (TB) risk by 24% overall, with even greater effectiveness in high TB burden regions. Isoniazid (INH) monotherapy for 9 to 12 months reduced TB risk by 46% (risk ratio [RR] = 0.54, 95% confidence interval [CI] = 0.35–0.85), while shorter-course rifamycin-based regimens showed no statistically significant protective effects.
Screening strategies also influenced TPT efficacy. Patients tested with both the tuberculin skin test (TST) and interferon-gamma release assays (IGRA) had the greatest benefit (RR = 0.58, 95% CI = 0.39–0.88). Among patients with rheumatic diseases (RD), those with systemic lupus erythematosus (SLE) had the highest initial TB risk (incidence rate [IR] = 9.5%), but TPT reduced the risk to 0.4%. Patients with arthritis, the largest group in the study, also saw a risk reduction (IR = 1.0% without TPT vs 0.7% with TPT).
TPT was particularly effective in TBI-positive patients, reducing TB risk by 89% (RR = 0.11, 95% CI = 0.04–0.32). Patients receiving disease-modifying antirheumatic drugs (DMARD) or glucocorticoids experienced greater benefit (RR = 0.44, 95% CI = 0.27–0.73) compared with those receiving tumor necrosis factor–alpha inhibitors, who saw a more modest reduction (RR = 0.67, 95% CI = 0.52–0.88).
In high TB burden regions, the initial TB incidence was nearly three times higher compared with in low-burden areas (IR = 2.7% vs 0.9%), but TPT significantly narrowed this gap. The investigators suggested extending INH treatment duration for better protection in these areas and called for more randomized controlled trials (RCT) to refine preventive strategies among patients with RDs.
The study, conducted under PRISMA guidelines and registered with PROSPERO (CRD42023473966), was supported by the National Natural Science Foundation of China, Capital’s Funds for Health Improvement and Research, and the National High-Level Hospital Clinical Research Funding.
"This meta-analysis systematically evaluated the effectiveness of TPT in patients with RDs and revealed that TPT is effective for overall patients with RDs," said lead study author Beiming Wang, of the Chinese Academy of Medical Sciences and Peking Union Medical College, and colleagues.
Despite strong evidence supporting TPT, the investigators highlighted gaps, including limited data on nonarthritis RD types and the need for RCTs comparing different regimens. They noted that future studies are planned to further evaluate TB prevention strategies in patients with RDs worldwide.
The authors reported no conflicts of interest.
