Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents
- Author(s)
- Eun Soo Kim; Geun Am Song; Kwang Bum Cho; Kyung Sik Park; Kyeong Ok Kim; Byung Ik Jang; Eun Young Kim; Seong Woo Jeon; Hyun Seok Lee; Chang Heon Yang; Yong Kook Lee; Dong Wook Lee; Sung Kook Kim; Tae Oh Kim; Jonghun Lee; Hyung Wook Kim; Sam Ryong Jee; Seun Ja Park; Hyun Jin Kim
- Keimyung Author(s)
- Kim, Eun Soo; Cho, Kwang Bum; Park, Kyung Sik
- Department
- Dept. of Internal Medicine (내과학)
- Journal Title
- World journal of Gastroenterology
- Issued Date
- 2015
- Volume
- 21
- Issue
- 11
- 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 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 mm3
(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.
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