Tuesday, October 04, 2005

TB

What would you do with an 80 year old with rheumatoid arthritis, no lung ivolvement, no lung symptoms who got a PPD prior to starting Enbrel and it was 20 mm? The CXR was negative and he has no constitutional symptoms. We could not elicit any history of prior exposure. He has not had any preious skin testing. He has no known rik factors.

4 comments - CLICK HERE to read & add your own!:

Baleeiro said...

This case is obviously complicated by his age. However, I'll suggest that if he is functional enough to get Enbrel ($1,275 for 4 syringes on the web) he should be able to tolerate INH for LTBI. Furthermore, his risk of having reactivation TB is greatly increased with Enbrel and four-drug Tx is much tougher to take than just INH.

Mendez said...

Agreed. In terms of timing, I would suggest that you start Embrel (at least) a few months after beginning INH.

Arenberg said...

I agree. I cringe saying it, but you are painted into a corner. The ATS statement says that persons not eligible for prophylactic therapy for LTBI should not be skin tested. I can understand testing someone before Enbrel Rx, but are they really going to give Enbrel to an 80 year old? I'd want to be sure he was really in a position to benefit from the Enbrel therapy (9.e. he is otherwise quite functional and has exhausted other therapeutic alternatives). His risk for INH hepatitis is substantial.

Jeff H said...

I agree. I think that to proceed with Enbrel in this patient, you'd have to treat for LTBI first.