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Ann Gastroenterol. 2015 Apr-Jun;28(2):241-246.

Latent tuberculosis screening tests and active tuberculosis infection rates in Turkish inflammatory bowel disease patients under anti-tumor necrosis factor therapy.

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Department of Gastroenterology (Cem Çekiç, Fatih Aslan, Sezgin Vatansever, Firdevs Topal, Elif Sarıtaş Yüksel, Emrah Alper, Belkıs Ünsal), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey.
Department of Chest Disease (Ayşe Dallı), Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey.



Tumor necrosis factor (TNF)-α inhibitors increase the risk of tuberculosis (TB). The objective of the present study was to determine the rate of active TB infection in inflammatory bowel disease (IBD) patients receiving anti-TNF therapy and to determine the results of their latent TB infection (LTBI) screening tests during the follow up.


This is a retrospective observational study of IBD patients receiving anti-TNF therapy. Tuberculin skin test (TST), interferon-γ release assay (IGRA), and chest radiography were used to determine LTBI. Active TB infection rate during anti-TNF treatment was determined.


Seventy-six IBD patients (25 with ulcerative colitis, 51 with Crohn's disease; 53 male; mean age 42.0±12.4 years) were included. Forty-four (57.9%) patients received infliximab and 32 (42.1%) adalimumab. Their median duration of anti-TNF therapy was 15 months. Forty-five (59.2%) patients had LTBI and received isoniazid (INH) prophylaxis. During the follow-up period, active TB was identified in 3 (4.7%) patients who were not receiving INH prophylaxis. There was a moderate concordance between the TST and the IGRA (kappa coefficient 0.44, 95% CI 0.24-0.76). Patients with or without immunosuppressive therapy did not differ significantly with respect to TST (P=0.318) and IGRA (P=0.157).


IBD patients receiving anti-TNF therapy and prophylactic INH have a decreased risk of developing active TB infection. However, despite LTBI screening, the risk of developing active TB infection persists.


Inflammatory bowel disease; anti-TNF therapy; interferon-γ release assay; tuberculin skin test; tuberculosis


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