Tumor Necrosis Factor-Antagonist Therapy Exposure Associated with Sputum Conversion by Eight Weeks among United States Tuberculosis Patients, 2010-2015 Público

Abstract

Immunosuppressive therapy through the use of Tumor Necrosis Factor (TNF) antagonists has been linked to activation of latent Tuberculosis (TB) infection to active TB disease. Less is known, however, about the effect of anti-TNF therapy on TB disease presentation, and on the course of TB disease after patients start on anti-TB therapy. Sputum culture conversion after the 2-month intensive phase of TB treatment serves as a biomarker of long-term cure and of contagiousness. We reviewed Reports of Verified Cases of Tuberculosis for all patients diagnosed in the United States and its territories from 2010-2015 through the National Tuberculosis Surveillance System (NTSS), which collects clinical and demographic patient data. Logistic models were used to estimate the adjusted odds ratios (aORs) for sputum conversion by 2 months or after. In the study population (n=26,861), sputum conversion by 8 weeks was observed in 15,915 (59.2%) patients. Anti-TNF exposure was significantly associated with a reduction in sputum conversion after 8 weeks among US-born patients (aOR: 0.2624, 95% confidence interval: (0.01, 0.70), p-value 0.0067), adjusting for other clinical and demographic factors. This data may serve to reassure TB patients on anti-TNF therapy that their TB outcomes will likely be better than their other TB counterparts, and could also have implications on contagiousness of anti-TNF patients.

Table of Contents

Table of Contents

BACKGROUND........................................................................................................ 1

METHODS.............................................................................................................. 4

Study Sample................................................................................................ 4

Variable Definition and Collection Methods......................................................... 4

Statistical Methods.......................................................................................... 5

RESULTS................................................................................................................ 6

DISCUSSION.......................................................................................................... 9

REFERENCES........................................................................................................ 12

TABLES AND FIGURES............................................................................................ 16

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Palavra-chave	Tuberculosis Sputum Conversion TB TNF Immunosuppression
Committee Chair / Thesis Advisor	Castro, Kenneth G, Emory University
Committee Members	Bamrah Morris, Sapna, Centers for Disease Control and Prevention Goswami, Neela , Emory University
Partnering Agencies	CDC

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