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Risks for opportunistic tuberculosis infection in a cohort of 873 patients with inflammatory bowel disease receiving a tumor necrosis factor-alpha inhibitor

Title
Risks for opportunistic tuberculosis infection in a cohort of 873 patients with inflammatory bowel disease receiving a tumor necrosis factor-alpha inhibitor
Authors
Byun, Ja MinLee, Chang KyunRhee, Sang YoulKim, Hyo-JongIm, Jong PilPark, Dong IlEun, Chang SooJung, Sung-AeShin, Jeong EunLee, Kang-MoonCheon, Jae Hee
Ewha Authors
정성애
SCOPUS Author ID
정성애scopus
Issue Date
2015
Journal Title
SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY
ISSN
0036-5521JCR Link1502-7708JCR Link
Citation
vol. 50, no. 3, pp. 312 - 320
Keywords
inflammatory bowel diseaselatent tuberculosis infectiontuberculosistumor necrosis factor-alpha inhibitor
Publisher
INFORMA HEALTHCARE
Indexed
SCI; SCIE; SCOPUS WOS
Abstract
Objective. Real-world epidemiological data on tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) receiving TNF-alpha inhibitors are scarce. We investigated the risks for and case characteristics of TB in a large cohort of IBD patients treated with TNF-alpha inhibitors in Korea, where TB is endemic. Materials and methods. We performed an observational study on all TB cases identified in a cohort of 873 IBD subjects treated with TNF-alpha inhibitors from January 2001 to December 2013. The standardized incidence ratio (SIR) of TB was calculated using data from the matched general population. Results. A total of 25 newly developed TB cases were identified in the cohort (pulmonary TB, 84% [21/25]; extrapulmonary TB, 16% [4/25]). The adjusted SIR of TB was 41.7 (95% confidence interval, 25.3-58.0), compared with that of the matched general population. Nineteen of the 25 patients (76%) developed TB within 2-62 months of initiation of TNF-alpha inhibitor treatment despite screening negative for latent TB infection (LTBI), whereas three patients with LTBI (12%, 3/25) developed TB 3 months after completion of chemoprophylaxis. The outcomes of TB treatment were mostly favorable, although one death from peritoneal TB was noted. The type of TNF-alpha inhibitor prescribed (infliximab) was a significant predictor of TB (p = 0.033). Conclusions. TNF-alpha inhibitor treatment strikingly increases the risk of TB infection in an IBD population from a TB endemic area. Continuous evaluation of the development of de novo TB infection in IBD patients subjected to long-term TNF inhibitor therapy is mandatory.
DOI
10.3109/00365521.2014.1000960
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의학전문대학원 > 의학과 > Journal papers
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