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P329. Tuberculosis infection in patients with inflammatory bowel diseases receiving anti-TNF agents: report of a case series of 99 patients

A. Hernandez Camba1, H. Izaguirre2, I. Alonso1, M. Carrillo1, L. Ramos1, H. Gonzalez2, E. Quintero1, 1Hospital Universitario de Canaris, Gastroenterology, La Laguna, Spain, 2Hospital Universitario de Canaris, Pneumology, La Laguna, Spain

Background

The advent of anti-TNF therapy (aTNFT) has provided an effective therapeutic approach for induction and maintenance remission in inflammatory bowel diseases (IBD). However, increased susceptibility to tuberculosis (TB) occurs following treatment with anti-TNF agents raising four to 20 folds with infliximab. Currently recommended screening for latent TB (LTB) before aTNFT should reduce TB reactivation about 90%. However, information about relationship between TB, aTNFT and IBD is limited. The objetive of this study is to evaluate the incidence of LTB and active TB (ATB) in IBD patients before and during aTNFT.

Methods

Ninety-nine IBD patients (47M/52F, mean age = 39.6 years, Crohn's disease (CD) n = 88, ulcerative colitis (UC) n = 10, indeterminate colitis (IC) n = 1) receiving aTNFT were retrospectively analyzed between August 2008 and October 2012. Data regarding time from diagnosis, site of disease and indication of aTNFT were collected. Glucocorticoids (GC) and immunosuppressant treatments were evaluated. Recommended studies for screening TB (clinical history, chest X-ray and the tuberculin skin test (TST) with re-TST for booster effect) performed prior therapy were revised. LTB was determinated by positive TST (>5 mm) and/or pathological chest X-ray. ATB must be confirmed by positive culture to Mycobacterium tuberculosis.

Results

The main indication for aTNFT was corticodependency (31.3%) usually associated to immunomodulators (86.9%; Azathioprine 69.7%). During aTNFT, GC were needed in 17.1% of cases. In 5 out of 99 (5%) patients, 5 had LTB and started TB chemoprophylaxis with isoniazid at least one month prior to aTNFT and none develop an ATB infection during the observation period (21.6 months). Two cases of ATB were developed during aTNFT, one disseminated form (CD/M, 39 years, positive sputum culture) and a pulmonary disease (UC/F, 23 years/positive sputum culture) aTNFT were discontinued at diagnosis in both cases and completed a one year regimen for ATB. Both cases had a negative screening study for TB prior aTNFT.

Conclusion

The incidence of LTB in this group before aTNFT was 5%. Despite screening for LTB 2% of patients developd ATB. New studies must improve the diagnosis of latent TB before anti-TNF agents and monitoring for TB in patients during therapy.