Abstract
BACKGROUND: Patients with rheumatic disease (RD) are particularly vulnerable to progressing to tuberculosis disease (TBD). The effectiveness of tuberculosis preventive treatment (TPT) in this high risk group needs systematic assessment. METHODS: We conducted a systematic review and meta-analysis by searching PubMed, Embase, the Cochrane Library, Web of Science, Scopus, and China National Knowledge Internet (CNKI) for relevant cohort studies from inception through January 2025. Eligible studies evaluated the incidence of TBD and/or the effectiveness of TPT in patients with RD. Two authors independently reviewed and extracted summary data from published reports. Pooled incidence rate (IR), risk ratio (RR) and their 95% confidence interval (CI) were calculated as the primary effect measure. Prospero registration number is CRD42023473966. FINDINGS: 64 studies with 116,015 patients with RD were included to evaluate effectiveness of TPT. TPT decreased the overall risk of TBD in patients with RD (RR: 0.76, 95% CI 0.63-0.91). TPT showed better effectiveness in high tuberculosis (TB) burden countries/regions (RR: 0.46, 95% CI 0.27-0.77). Using isoniazid (INH) monotherapy for 9-12 months was effective (RR: 0.54, 95% CI 0.35-0.85). Taking tuberculin skin test (TST) combined with interferon gamma release assays (IGRA) as tuberculosis infection (TBI) screening methods might maximize the benefits of TPT (RR: 0.58, 95% CI 0.39-0.88). TPT showed optimal protective effects in patients with RD in TBI positive status (RR: 0.11, 95% CI 0.04-0.32). Compared with patients with RD receiving biologics, TPT showed better effects in patients with RD only receiving traditional treatment (RR: 0.44, 95% CI 0.27-0.73). And TPT performed more effectively in systematic lupus erythematosus (SLE) than arthritis. INTERPRETATION: TPT decreased the risk of TBD in patients with RD, especially in TB high burden countries/regions. When using isoniazid monotherapy, extending the treatment course might have better protection. TST combined with IGRA might be optimal when screening the TBI. More types of RDs, short-course regimens containing rifamycins and high-quality randomized controlled trials (RCT) should be the focus of future research. FUNDING: This study was supported by the National Natural Science Foundation of China (82373648), Capital's Funds for Health Improvement and Research (2024-2-4016), and the National High Level Hospital Clinical Research Funding (2022-PUMCH-C-013, 2022-PUMCH-A-119).