Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents

Abstract

AIM:To evaluate the incidence and risk factors of Korean tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) undergoing anti-TNF treatment. METHODS:The data of IBD patients treated with anti-TNFs in 13 tertiary referral hospitals located in the southeastern region of Korea were collected retrospectively. They failed to show response or were intolerant to conventional treatments, including steroids or immunomodulators. Screening measures for latent TB infection (LTBI) and the incidence and risk factors of Retrospective Study ORIGINAL ARTICLEactive TB infection after treatment with anti-TNFs were identified. RESULTS:Overall, 376 IBD patients treated with anti-TNF agents were recruited (male 255, mean age of anti-TNF therapy 32.5 ± 13.0 years); 277 had Crohn's disease, 99 had ulcerative colitis, 294 used infliximab, and 82 used adalimumab. Before anti-TNF treatment, screening tests for LTBI including an interferon gamma release assay or a tuberculin skin test were performed in 82.2% of patients. Thirty patients (8%) had LTBI. Sixteen cases of active TB infection including one TB-related mortality occurred during 801 personyears (PY) follow-up (1997.4 cases per 100000 PY) after anti-TNF treatment. LTBI (OR = 5.76, 95%CI:1.57-21.20, P = 0.008) and WBC count < 5000 mm 3 (OR = 4.5, 95%CI: 1.51-13.44, P = 0.007) during follow-up were identified as independently associated risk factors. CONCLUSION:Anti-TNFs significantly increase the risk of TB infection in Korean patients with IBD. The considerable burden of TB and marked immunosuppression might be attributed to this risk.

Tuberculosis screening prior to anti‐tumor necrosis factor therapy among patients with immune‐mediated inflammatory diseases in Japan: a longitudinal study using a large‐scale health insurance claims database

“…Higher proportions of the patients who underwent screening were observed in the sensitivity analyses, but the data still suggest that about a quarter of patients do not undergo TST/IGRA. Although only a few studies have reported the frequency of tuberculosis screening of patients receiving anti‐TNF therapy, the proportion of the patients who had undergone TST/IGRA in the present study (66% in the base‐case analyses and 74–78% in the sensitivity analyses) was substantially lower than the proportions reported in post‐marketing surveillance of ETN (94%) and ADA (89%) prescribed for rheumatoid arthritis patients in Japan, and also lower than that in a hospital‐based study of inflammatory bowel disease in Korea (82%) . The proportion was even lower for the screening combined with chest radiography.…”

Challenges in screening for latent tuberculosis in inflammatory bowel disease prior to biologic treatment: a UK cohort study

“…Our rate for presumed LTBI (4%) was also lower than in a Korean cohort of anti-TNF treated patients 11. These differences probably reflect our strategy of active identification of LTBI through screening, and different background TB incidence rates.…”

Infection‐related hospitalizations in the first year after inflammatory bowel disease diagnosis

“…The interferon gamma release assay is also not widely available in local public hospitals. In a recent Korean study 4.2% of patients were reported to develop active tuberculosis infection after using anti‐TNF agents . Hence, it is mandatory to have adequate screening of these patients prior to the initiation of anti‐TNF therapy in Asia.…”