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J Crohns Colitis. 2016 Oct;10(10):1186-93. doi: 10.1093/ecco-jcc/jjw022. Epub 2016 Jan 22.

Tuberculosis in Anti-Tumour Necrosis Factor-treated Inflammatory Bowel Disease Patients After the Implementation of Preventive Measures: Compliance With Recommendations and Safety of Retreatment.

Author information

1
Complexo Hospitalario Universitario de Pontevedra. Instituto de Investigación Biomédica Galicia Sur (IBI), Spain daniel.carpio.lopez@sergas.es.
2
Hospital Clinic i Provincial, Barcelona, Spain.
3
Hospital Central de Asturias, Oviedo, Spain.
4
Complexo Hospitalario Universitario, Vigo, Spain.
5
Complexo Hospitalario Universitario, Santiago de Compostela, Spain.
6
Hospital Clínico, Madrid, Spain.
7
Hospital de Badalona, Barcelona, Spain.
8
Hospital Universitario Arquitecto Marcide, Ferrol, Spain.
9
Hospital Universitario Marqués de Valdecilla, Santander, Spain.
10
Complexo Universitario Juan Canalejo, A Coruña, Spain.
11
Hospital Virgen de Altagracia, Manzanares, Ciudad Real, Spain.
12
Complejo Hospitalario, León, Spain.
13
Hospital Rio Hortega, Valladolid, Spain.
14
Hospital Infanta Cristina de Parla, Madrid, Spain.
15
Clínica Puerta de Hierro, Madrid, Spain.
16
Servicio de Aparato Digestivo, Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
17
Hospital Son Espases, Palma de Mallorca, Spain.
18
Hospital de Fuenlabrada, Madrid, Spain.
19
Hospital de Manises, Valencia, Spain.
20
Institut Universitàri Parc Taulí, Sabadell, Spain.
21
Complexo Hospitalario Universitario de Pontevedra. Instituto de Investigación Biomédica Galicia Sur (IBI), Spain.
22
Hospital Santa Creu i Sant Pau, Barcelona, Spain.
23
Hospital de Valme, Sevilla, Spain.

Abstract

BACKGROUND AND AIMS:

Despite having adopted preventive measures, tuberculosis (TB) may still occur in patients with inflammatory bowel disease (IBD) treated with anti-tumour necrosis factor (anti-TNF). Data on the causes and characteristics of TB cases in this scenario are lacking. Our aim was to describe the characteristics of TB in anti-TNF-treated IBD patients after the publication of the Spanish TB prevention guidelines in IBD patients and to evaluate the safety of restarting anti-TNF after a TB diagnosis.

METHODS:

In this multicentre, retrospective, descriptive study, TB cases from Spanish hospitals were collected. Continuous variables were reported as mean and standard deviation or median and interquartile range. Categorical variables were described as absolute and relative frequencies and their confidence intervals when necessary.

RESULTS:

We collected 50 TB cases in anti-TNF-treated IBD patients, 60% male, median age 37.3 years (interquartile range [IQR] 30.4-47). Median latency between anti-TNF initiation and first TB symptoms was 155.5 days (IQR 88-301); 34% of TB cases were disseminated and 26% extrapulmonary. In 30 patients (60%), TB cases developed despite compliance with recommended preventive measures; *not performing 2-step TST (tuberculin skin test) was the main failure in compliance with recommendations. In 17 patients (34%) anti-TNF was restarted after a median of 13 months (IQR 7.1-17.3) and there were no cases of TB reactivation.

CONCLUSIONS:

Tuberculosis could still occur in anti-TNF-treated IBD patients despite compliance with recommended preventive measures. A significant number of cases developed when these recommendations were not followed. Restarting anti-TNF treatment in these patients seems to be safe.

KEYWORDS:

Anti-TNF; Crohn’s disease; adalimumab; inflammatory bowel disease; infliximab; prevention; retreatment; tuberculosis; ulcerative colitis

PMID:
26802085
DOI:
10.1093/ecco-jcc/jjw022
[Indexed for MEDLINE]

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