Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on screening and treatment of tuberculosis infection in patients with inflammatory bowel disease

Riestra, Sabino; Taxonera, Carlos; Zabana, Yamile; Carpio, Daniel; Beltrán, Belén; Mañosa, Míriam; Gutiérrez, Ana; Acosta, Manuel Barreiro‐de

doi:10.1016/j.gastre.2020.04.006

Cited by 6 publications

(6 citation statements)

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“…Physicians and health personnel that treat patients with IBD should continue to actively and routinely search for latent TB through periodic reevaluations with targeted consultation and should note classic TB symptoms, such as cough, fever, weight loss, night sweating, performance laboratory tests, chest X-ray, and tomography, even when patients have taken the medication for a long period, since there is no single criterion standard test for detecting the disease [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Neurotuberculosis in a Patient with Ulcerative Colitis Using Long-Term Adalimumab: A Rare Case

Facanali

Safatle‐Ribeiro

et al. 2023

Am J Case Rep

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Objective:Rare disease Background:Tuberculosis (TB), a global public health problem, is a disease with a high incidence and prevalence worldwide.The risk of developing TB increases after starting anti-tumor necrosis factor (TNF) therapy in the management of ulcerative colitis (UC). Isolated neurotuberculosis (NTB) without other manifestations is a rare form of infection in these patients. This article reports a case of a severe UC patient with isolated NTB following long-term therapy with adalimumab and discusses the clinical aspects, diagnosis, management, and prognosis. Case Report:A 34-year-old female patient with severe UC with pancolitis reported continuous and progressive holocranial headaches associated with a daily fever of 38°C and night sweats after 4 years of using adalimumab and after being in deep remission. Annually, she was screened for latent TB with chest X-rays and a Mantoux tuberculin skin test, and she always had negative results for TB. On cerebral magnetic resonance imaging with postcontrast sequences, small cortical lesions in the left frontal lobe and 2 larger lesions were visualized and were suggestive of tuberculomas. The initial management consisted of the suspension of immunosuppressive therapy and treatment with rifampicin, isoniazid, ethambutol, pyrazinamide, and prednisone. The patient showed clinical and neurological improvement and was clinically asymptomatic, with no changes in laboratory tests. Also, she had no neurological sequelae and was taking maintenance therapy with prednisone as indicated by the neurologist. Conclusions:Early recognition of symptoms of neurological involvement of TB, suspension of anti-TNF and adequate treatment are fundamental steps to prevent complications.

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Section: Discussionmentioning

confidence: 99%

Neurotuberculosis in a Patient with Ulcerative Colitis Using Long-Term Adalimumab: A Rare Case

Facanali

Safatle‐Ribeiro

et al. 2023

Am J Case Rep

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“…It is justified by the possible subsequent need for the use of biologics and/or immunosuppressants. It will consist of an adequate clinical history to detect possible contacts and a Mantoux skin test (TST) 6 . Chest X-ray as a screening method should only be performed if the screening is positive or if there has been recent contact with a person with TB, to rule out active infection (Fig.…”

Section: Mycobacterium Tuberculosis Infectionmentioning

confidence: 99%

“…Chemoprophylaxis of latent TB infection will usually be carried out with isoniazid at a dose of 5 mg/kg/day (maximum 300 mg/day), preferably at least 3 weeks before starting anti-TNF and maintained for 9 months. In cases of urgent need to start anti-TNF, both can be started as little as 1 week apart 6 .…”

Section: Mycobacterium Tuberculosis Infectionmentioning

confidence: 99%

Review of the safety with biologics in inflammatory bowel disease

Pascual¹,

Vicente²,

Sierra³

et al. 2023

JIMIDS

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Biologics have completely changed the treatment (and life) of patients with inflammatory bowel disease (IBD). After the first ones, anti-tumor necrosis factor (TNF) biologics, two new biologics, with other therapeutic targets, are now in routine use in our patients, and some others are in different stages of research. They share many aspects, but differ in others, so their efficacy and safety may be different. Having predictors of efficacy and safety in a particular patient are one of the greatest challenges in IBD therapy, but we are far from achieving it. In any case, safety is key, especially in drugs used as maintenance therapy in a chronic disease such as IBD. Although biologics are generally safe when are used correctly, it is essential to be aware of their potential adverse events and their particularities in different situations. To minimize them, it is essential to use them in the ideal patient, to choose the right biologic at the right time, to carry out a series of prior measures before start them, and, finally, to monitor the treatment correctly. We will discuss the differences between biologics, essentially anti-TNF versus ustekinumab versus vedolizumab, in terms of adverse events as well as their particularities of use. Having the knowledge of their contraindications, use in special populations, the steps before start, and how to monitoring them is essential. Although sometimes there are alternatives to biologics such as "the new small molecules, " they are not the purpose of this review.

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“…In patients with more than one LTBI screening test recorded in the database, the result of the first screening was taken into account to evaluate the frequency of LTBI. A patient was considered to have LTBI if there was a positive result in either screening test (positive IGRA and/or TST > 5 mm), when there were lesions suggestive of an old TB infection on a chest X-ray (calcified nodes or nodules, pleural apical thickening, fibrous tracts), or when recent contact with a bacilliferous TB patient was identified [19].…”

Section: Study Population and Definitionsmentioning

confidence: 99%

“…In 2014, it was estimated that the prevalence of LTBI in Spain was 15% (95% CI 6.3-27%) [18], whereas the data reported for IBD patients was highly variable (13-34%) [10][11][12]. Taking these data into account, the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) published its updated recommendations for the screening and treatment of LTBI in 2021 [19] and recommended single screening (TST) for immunocompetent patients and dual screening (TST/IGRA) for immunocompromised patients.…”

Section: Introductionmentioning

confidence: 99%

Performance of Screening Strategies for Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease: Results from the ENEIDA Registry of GETECCU

Riestra

Taxonera

Zabana

et al. 2022

JCM

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(1) Aims: Patients receiving antitumor necrosis factor (anti-TNF) therapy are at risk of developing tuberculosis (TB), usually due to the reactivation of a latent TB infection (LTBI). LTBI screening and treatment decreases the risk of TB. This study evaluated the diagnostic performance of different LTBI screening strategies in patients with inflammatory bowel disease (IBD). (2) Methods: Patients in the Spanish ENEIDA registry with IBD screened for LTBI between January 2003 and January 2018 were included. The diagnostic yield of different strategies (dual screening with tuberculin skin test [TST] and interferon-ץ-release assay [IGRA], two-step TST, and early screening performed at least 12 months before starting biological treatment) was analyzed. (3) Results: Out of 7594 screened patients, 1445 (19%; 95% CI 18–20%) had LTBI. Immunomodulator (IMM) treatment at screening decreased the probability of detecting LTBI (20% vs. 17%, p = 0.001). Regarding screening strategies, LTBI was more frequently diagnosed by dual screening than by a single screening strategy (IGRA, OR 0.60; 95% CI 0.50–0.73, p < 0.001; TST, OR 0.76; 95% CI 0.66–0.88, p < 0.001). Two-step TST increased the diagnostic yield of a single TST by 24%. More cases of LTBI were diagnosed by early screening than by routine screening before starting anti-TNF agents (21% [95% CI 20–22%] vs. 14% [95% CI 13–16%], p < 0.001). The highest diagnostic performance for LTBI (29%) was obtained by combining early and TST/IGRA dual screening strategies in patients without IMM. (4): Conclusions: Both early screening and TST/IGRA dual screening strategies significantly increased diagnostic performance for LTBI in patients with IBD, with optimal performance achieved when they are used together in the absence of IMM.

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Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on screening and treatment of tuberculosis infection in patients with inflammatory bowel disease

Cited by 6 publications

References 86 publications

Neurotuberculosis in a Patient with Ulcerative Colitis Using Long-Term Adalimumab: A Rare Case

Neurotuberculosis in a Patient with Ulcerative Colitis Using Long-Term Adalimumab: A Rare Case

Review of the safety with biologics in inflammatory bowel disease

Performance of Screening Strategies for Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease: Results from the ENEIDA Registry of GETECCU

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