Tuberculous chemoprophylaxis requirements and safety in inflammatory bowel disease patients prior to anti-TNF therapy

Zabana, Yamile; Domènech, Eugeni; Román, Antonio; Beltrán, Belén; Cabriada, José Luis; Saro, Cristina; Araméndiz, Robert; Ginard, Daniel; Hinojosa, Joaquín; Gisbert, Javier P.; Mañosa, Míriam; Cabré, Eduard; Gassull, Miquel A.

doi:10.1002/ibd.20496

Cited by 45 publications

(16 citation statements)

References 19 publications

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“…65 A recent study found that chemoprophylaxis is safe in IBD patient candidates for anti-TNF therapy, even if taking concomitant potentially hepatotoxic drugs. 66 However, it is still recommended that all patients receiving INH prophylaxis should be monitored monthly for clinical symptoms of hepatitis. Baseline (up to 6 months after starting therapy) liver enzymes and liver function tests are only recommended for high-risk groups, such as those with underlying chronic liver disease, immunosuppressed patients, and those receiving concomitant hepatoxic therapy.…”

Section: Antituberculosis (Tb) Prophylaxis During Anti-tnf Therapymentioning

confidence: 99%

Liver diseases associated with anti-tumor necrosis factor-alpha (TNF-α) use for inflammatory bowel disease

Coffin¹,

Fraser²,

Panaccione³

et al. 2011

Inflammatory Bowel Diseases

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The conventional treatment of inflammatory bowel disease (IBD) has focused on nonspecifically targeting mucosal inflammation. In the last decade, with the advent of novel biological agents that directly inhibit proinflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), rapid progress has been made in clinical management of complex and challenging patients with IBD. However, there remain many unanswered questions about the short and long-term side effects; this article focuses on hepatic complications. This review aims to provide a concise update to gastroenterologists on the well-known, as well as the potential rare consequences of anti-TNFα therapy on the liver and recommendations for clinical management. We performed a focused literature review for reports of the effect of anti-TNF therapy on preexisting liver disease as well as de novo hepatitis and drug-induced hepatotoxicity. Search terms used included anti-TNF therapy, biologics, liver disease, inflammatory bowel disease, hepatitis, hepatotoxicity, opportunistic infections,, and hepatitis virus reactivation. There are multiple potential effects of anti-TNF therapy on the liver during treatment of patients with IBD. Often treatment may be complicated by preexisting chronic liver disease. Clinicians should be aware of potential hepatic side effects and appropriate management options.

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Section: Antituberculosis (Tb) Prophylaxis During Anti-tnf Therapymentioning

confidence: 99%

Liver diseases associated with anti-tumor necrosis factor-alpha (TNF-α) use for inflammatory bowel disease

Coffin¹,

Fraser²,

Panaccione³

et al. 2011

Inflammatory Bowel Diseases

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“…Four of eight patients developed moderately severe DILI, of whom three had to discontinue INH treatment [111] . Other series, however, suggest a lower rate of hepatoxicity [112,113] . The risk of DILI appears to be higher when INH is given in combination with rifampin or pyrazinamide [109,114] .…”

Section: Dili From Agents Used To Treat Complications Of Ibd Therapiesmentioning

confidence: 99%

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

Khokhar

Lewis²

2010

Dig Dis

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Patients with inflammatory bowel disease (IBD) are at risk for hepatobiliary disease and toxicity, and the diagnosis of drug-induced liver disease in patients being treated for IBD can represent a clinical challenge. There are a number of disease states associated with IBD, which are primary sclerosing cholangitis, cholangiocarcinoma and autoimmune hepatitis. There is a wide spectrum of hepatic injury that can occur from the agents used to treat IBD, such as acute or chronic hepatic injury directly attributable to the drugs used to treat IBD (e.g. sulfasalazine, mesalamine, thiopurines, methotrexate, TNF antagonists, quinolone antibiotics); liver toxicity from drugs used to treat complications of immunomodulators and TNF antagonists (e.g. isoniazid for treatment of reactivation tuberculosis), and exacerbation of underlying chronic viral hepatitis with infliximab and other TNF antagonists. Thiopurines are also associated with the development of hepatic vascular lesions, such as nodular regenerative hyperplasia and peliosis hepatic. In addition, biologics can be associated with the reactivation of underlying chronic viral hepatitis, mandating universal screening prior to initiation of TNF-alpha antagonist therapy.

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“…The incidence of active TB in our area is low (11 cases per 100,000 people in 2014) (15); however, the prevalence of LTBI in patients with IBD in our area is high, at 33.5% (16), in comparison with other Spanish regions (range, 4.5% to 12.5%) (4,6,17).…”

Section: Discussionmentioning

confidence: 84%

Risk factors for tuberculosis in inflammatory bowel disease: anti-tumor necrosis factor and hospitalization

et al. 2016

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Aims: To determine risk factors for active tuberculosis in patients with inflammatory bowel diseases.Methods: Retrospective, case-control study at 4 referral hospitals in Spain. Cases developed tuberculosis after a diagnosis of inflammatory bowel disease. Controls were inflammatory bowel disease patients who did not develop tuberculosis. For each case, we randomly selected 3 controls matched for sex, age (within 5 years) and time of inflammatory bowel disease diagnosis (within 3 years). Inflammatory bowel disease characteristics, candidate risk factors for tuberculosis and information about the tuberculosis episode were recorded. Multivariate analysis and a Chi-squared automatic interaction detector were used.Results: Thirty-four cases and 102 controls were included. Nine of the 34 cases developed active tuberculosis between 1989 and 1999, and 25 became ill between 2000 and 2012. Multivariate regression showed an association between active tuberculosis and anti-TNF (tumor necrosis factor) therapy in the previous 12 months (OR 7.45; 95% CI, 2.39-23.12; p = 0.001); hospitalization in the previous 6 months (OR 4.38; 95% CI, 1.18-16.20; p = 0.027); and albumin levels (OR 0.88; 95% CI, 0.81-0.95; p = 0.001). The median time between the start of biologic therapy and the onset of active tuberculosis was 13 (interquartile range, 1-58) months. Tuberculosis developed after a year of anti-TNF therapy in 53%, and late reactivation occurred in at least 3 of 8 patients.Conclusions: The main risks factors for developing tuberculosis were anti-TNF therapy and hospitalization. Over half the cases related to anti-TNF treatment occurred after a year.

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Tuberculous chemoprophylaxis requirements and safety in inflammatory bowel disease patients prior to anti-TNF therapy

Cited by 45 publications

References 19 publications

Liver diseases associated with anti-tumor necrosis factor-alpha (TNF-α) use for inflammatory bowel disease

Liver diseases associated with anti-tumor necrosis factor-alpha (TNF-α) use for inflammatory bowel disease

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

Risk factors for tuberculosis in inflammatory bowel disease: anti-tumor necrosis factor and hospitalization

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