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Background: TNFα-inhibitor(TNF-αI) treatment increases tuberculosis(Tb) risk.Whenever Tb develops, guidelines recommend to stop TNF-αIs.However, this may result in flare of the underlying disease.There is limited data about the safety of re-administration of biologics. Objective: To determine the safety of re-administration of biologic agents in patients who developed Tb during TNF-αI-treatment. Methods: 21 of 1867 rheumatology patients(11 men, mean age 38.4±13.2 years;mean disease duration 10.6±7.8 years) developed Tb(8 pulmonary, 13 extrapulmonary) under TNF-αI(15 with infliximab,3 adalimumab,3 etanercept).The mean follow-up period was 38.1±28.5 months. Results: Among 21 Tb patients,1 had military-Tb and died during the first month of Tb-treatment.TNF-αI was restarted in 15/20 remaining patients(75%).In 3 patients TNF-αI was restarted while Tb-treatment was ongoing (etanercept in 1 Behcet9s patient at month 3,rituximab in 2 RA patients at month 4),and in 12 patients, median 3.5 months (IQR:0.6-22.2 months) after Tb-treatment was completed.Tb relapsed as pulmonary-Tb in one Behcet patient on 18th month of infliximab. Infliximab was stopped and Tb-retreatment started for 6 months.At the 3rd month of Tb-treatment,etanercept was started due to severe uveitis and switched to canakinumab due to inadequate response after 15 months.After 3rd dose of canakinumab,the patient developed TB-meningitis and received another 9 months of anti-Tb treatment and is currently stable on Interferon-alpha therapy for 16 months. Conclusion: Biologic agents including TNF-αI,can be restarted in patients who had previously developed Tb under anti-TNF treatment.Careful follow-up for TB relapse is required.

Aims: TNF-alpha inhibitors widely used for the treatment of chronic inflammatory diseases in recent years. The increased risk of tuberculosis (TB) is the most important side effects of TNF-alpha inhibitors useage. We want to share the features of 19 patients who developed TB during the treatment of TNF-alpha inhibitors. Findings: The data files of patients who admitted to approval for the TNF-alpfa inhibitors treatment, were retrospectively evaluated between 2002-2014. 19 patients developped TB. 9(%47) patients were female, 10(%53) were male. The average age of patients were 38,4±13,9. 12(%63.2) patients were still smoking (40±11,8 packet-year), 7(%36,8) patients who never smoked. The primary disease for using TNF alpha inhibitors treatment were; 10 patients with ankylosing spondylitis, 4 Rheumatoid Arthritis, 3 patients with Behcet9s disease, 1 Takayasu Arteritis, 1 Psoriatic Arthritis. 9 patients used Infliximab, 6 Adalimumab, 4 Enbrel treatment. The PPD values of the patient;7 patients were 0mm, 11 were ppd ≥5mm, we didnt apply ppd test to 1 patient because of previous history of anti-tuberculosis treatment. 11 (%57,7) patients received INH prophylaxis, 8 (%42.1) patients didn9t. Culture positive pulmonaryTB occurred in 7 patients (%36,8), 12 (63.2%) patients developped extrapulmonary TB (4 miliary TB, 3 tuberculous pleurisy, 2 patients with gastrointestinal TB, 1 tuberculosis lymphadenitis, 1 urogenital TB, 1 ear TB). All patients have completed the tuberculosis treatment. Conclusion: The TB risk is increased in patients who use TNF alpha inhibitor therapy, and majority of them are extrapulmonary tuberculosis. The clinicians must be careful in terms of extrapulmonary tuberculosis in these patients.