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Multicenter Study
. 2015 Mar 21;21(11):3308-16.
doi: 10.3748/wjg.v21.i11.3308.

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

Eun Soo Kim  1 , Geun Am Song  1 , Kwang Bum Cho  1 , Kyung Sik Park  1 , Kyeong Ok Kim  1 , Byung Ik Jang  1 , Eun Young Kim  1 , Seong Woo Jeon  1 , Hyun Seok Lee  1 , Chang Heon Yang  1 , Yong Kook Lee  1 , Dong Wook Lee  1 , Sung Kook Kim  1 , Tae Oh Kim  1 , Jonghun Lee  1 , Hyung Wook Kim  1 , Sam Ryong Jee  1 , Seun Ja Park  1 , Hyun Jin Kim  1
Affiliations
Multicenter Study

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

Eun Soo Kim et al. World J Gastroenterol. .

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 active 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 person-years (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.

Keywords: Anti-TNF; Inflammatory bowel disease; Korea; Latent tuberculosis infection; Risk factor; Tuberculosis.

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Figures

Figure 1
Figure 1
Flow diagram of patients, illustrating screening outcomes. 1Chest X-ray, tuberculin skin test, or interferon gamma release assay; 2Development of active tuberculosis infection after anti-TNF therapy. LTBI: Latent tuberculosis infection.
Figure 2
Figure 2
Clinical symptoms (A) and involvement locations (B) of active tuberculosis infection after anti-TNF therapy in patients with inflammatory bowel disease.
See this image and copyright information in PMC

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