Tuberculosis in children using biological agents: A nationwide study

<bold>Objective:</bold> The use of biological agents in various diseases in children has been increasing. The risk of tuberculosis (TB) increases with these treatments. We aimed to investigate the clinical features of children using biological agents diagnosed as TB. <bold>Methods:</bold> ICD-10 codes related to TB were reviewed from the E-Nabız database of the Turkish Ministry of Health. Patients who were diagnosed with TB-related ICD-10 between 2018-2023 were included in the study. The number of patients, their demographic characteristics, the drug treatments used by the patients, underlying diseases, organ involvement of TB were recorded. <bold>Results:</bold> A total of 4351 children were diagnosed with TB, while 83 (1.9%) of them were using biological agents. Among 83 patients, 44.6% of them were female, and the mean age of diagnosis was 12.3±4.1 years; 48 had respiratory involvement, 25 extrapulmonary, and 10 both; 60% had rheumatological diseases, while the others had systemic diseases (Chron, psoriasis, etc.). While 64 used anti-TNF treatments, the remaining used other biological agents (anti-IL-6, IL-1, etc). The age of TB diagnosis was older in children using anti-TNF treatment (p=0.003). Extrapulmonary involvement was present in 60.6 % of children with rheumatological disease and 30% in the other systemic diseases (p=0.006). 44% of the children with respiratory involvement and 16% of children with extrapulmonary involvement used naproxen (p=0.014). In the logistic regression analyses, using naproxen increases the risk of respiratory involvement of TB (OR:3.824, p=0.033). <bold>Conclusion:</bold> Children using biological agents should be closely followed up in terms of TB, especially children who are also using naproxen.