Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 4:16:17562848231179871.
doi: 10.1177/17562848231179871. eCollection 2023.

Active tuberculosis in inflammatory bowel disease patients: a case-control study

Matheus Freitas Cardoso de Azevedo  1 , Luísa Leite Barros  2 , Filipe Fernandes Justus  2 , Jane Oba  2 , Karoline Soares Garcia  2 , Camilla de Almeida Martins  2 , Alexandre de Sousa Carlos  2 , André Zonetti Arruda Leite  2 , Aytan Miranda Sipahi  2 , Natália Sousa Freitas Queiroz  3 , Adérson Omar Mourão Cintra Damião  2
Affiliations

Active tuberculosis in inflammatory bowel disease patients: a case-control study

Matheus Freitas Cardoso de Azevedo et al. Therap Adv Gastroenterol. .

Abstract

Background/aims: Anti-tumor necrosis factor (anti-TNF) drugs have been the mainstay therapy for moderate to severe inflammatory bowel disease (IBD) over the past 25 years. Nevertheless, these drugs are associated with serious opportunistic infections like tuberculosis (TB). Brazil is ranked among the 30 countries with the highest incidence of TB in the world. This study aimed at identifying risk factors for the development of active TB and describing clinical characteristics and outcomes in IBD patients followed at a tertiary referral center in Brazil.

Methods: We conducted a retrospective, case-control study between January 2010 and December 2021. Active TB cases in IBD patients were randomly matched 1:3 to controls (IBD patients with no previous history of active TB) according to gender, age, and type of IBD.

Design: This was a retrospective, case-control study.

Results: A total of 38 (2.2%) cases of TB were identified from 1760 patients under regular follow-up at our outpatient clinics. Of the 152 patients included in the analysis (cases and controls), 96 (63.2%) were male, and 124 (81.6%) had Crohn's disease. Median age at TB diagnosis was 39.5 [interquartile range (IQR) 30.8-56.3]. Half of the active TB cases were disseminated (50%). Overall, 36 patients with TB (94.7%) were being treated with immunosuppressive medications. Of those, 31 (86.1%) were under anti-TNF drugs. Diagnosis of TB occurred at a median of 32 months after the first dose of anti-TNF (IQR 7-84). In multivariate analysis, IBD diagnosis older than 17 years and anti-TNF therapy were significantly associated with the development of TB (p < 0.05). After the TB treatment, 20 (52.7%) patients received anti-TNF therapy, and only one developed 'de novo' TB 10 years after the first infection.

Conclusions: TB remains a significant health problem in IBD patients from endemic regions, especially those treated with anti-TNFs. In addition, age at IBD diagnosis (>17 years old) was also a risk factor for active TB. Most cases occur after long-term therapy, suggesting a new infection. The reintroduction of anti-TNFs agents after the anti-TB treatment seems safe. These data highlight the importance of TB screening and monitoring in IBD patients living in endemic areas.

Keywords: Anti-TNF; Inflammatory bowel diseases; Tuberculosis.

PubMed Disclaimer

Conflict of interest statement

MFCA reports receiving consulting fees from Janssen and Takeda; lecture fees from Janssen, Takeda, Pfizer, and Abbvie; and travel grant support from Takeda, Janssen, and Abbvie. LLB reports receiving lecture fees from Janssen, Takeda, and UCB and travel grant support from Takeda and Janssen. ASC reports receiving lecture fees from Janssen, Takeda, and Abbvie and travel grant support from Takeda, Janssen, and Abbvie. NSFQ reports receiving consulting payments from Janssen, lecture fees from Janssen, Takeda, UCB, and Abbvie, and travel grant support from Takeda, Janssen, and Abbvie. AOMCD reports receiving lecture fees from Janssen, Takeda, and Abbvie and travel grant support from Takeda. JO, FFJ, KSG, CAM, AZAL, and AMS have no conflict of interest to declare. No other potential conflict of interest relevant to this letter was reported.

Figures

Figure 1.
Figure 1.
Flow chart of patients with inflammatory bowel disease included in the study.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Maaser C, Sturm A, Vavricka SR, et al.. ECCO-ESGAR guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 2019; 13: 144–164. - PubMed
    1. D’Haens GR, van Deventer S. 25 years of anti-TNF treatment for inflammatory bowel disease: lessons from the past and a look to the future. Gut 2021; 70: 1396–1405. - PubMed
    1. Lima CCG, Queiroz NSF, Sobrado CW, et al.. Critical analysis of anti-TNF use in the era of new biological agents in inflammatory bowel disease. Arq Gastroenterol 2020; 57: 323–332. - PubMed
    1. Queiroz NSF, Regueiro M. Safety considerations with biologics and new inflammatory bowel disease therapies. Curr Opin Gastroenterol 2020; 36: 257–264. - PubMed
    1. Fallahi-Sichani M, El-Kebir M, Marino S, et al.. Multiscale computational modeling reveals a critical role for TNF-α receptor 1 dynamics in tuberculosis granuloma formation. J Immunol 2011; 186: 3472–3483. - PMC - PubMed

LinkOut - more resources