P642. Frequency of tuberculosis in patients with inflammatory bowel disease (IBD) receiving anti-TNF therapy (infliximab) in Moscow region
N. Morozova1, E. Belousova1, O. Tsodikova1, E. Tagieva1, 1Moscow Regional Research Clinical Institute, Moscow, Russian Federation
The use of anti-TNF therapy, in particular infliximab may lead to the development of TBC-infection due to immunosuppressive action of biologics. Purpose of the study: To determine the frequency of TBC infection in IBD patient receiving infliximab in population of Moscow region (Moscow excluded) in Russia.
We observed 71 IBD patients: 45 with ulcerative colitis (UC) and 26 with Crohn's disease (CD) at the age of 18–54 years (mean age 37.5±4.1) M:F rate = 31:40. Duration of disease ranged from 6 months to 11 years (mean duration 6.8 years). Duration of infliximab treatment ranged from 6 months to 5 years (total 9248 pts·years). Before infliximab administration all patients were completely screened to exclude active TBC (chest x-rays, PPD test, physician examination, history of TBC and contacts with TBC patients were taken into account). Incidence of active TBC in Russia (66 per 100,000 population and 46 per 100,000 in Moscow region in 2011) is higher than in Europe and USA. It was the reason to repeat screening every 6 months due to possible higher TBC risk in this group of patients.
In 5 patients treated with infliximab active TBC was diagnosed (about 0.05/100 pts/years that is not higher than in the majority of countries). In all patients it was pulmonary tuberculosis. In 4 cases there was relapses of latent TBC that was not identified at the screening, 1 patient had primary TBC infection. Infliximab was discontinued after TBC diagnosis. Specific anti tuberculosis therapy was performed.
In countries and regions with a high TBC incidence the risk of TBC infection should be expected with use of biological agents in IBD patients. However in our IBD patients the frequency of TBC did not exceed TBC rate in other countries. We believe that complete TBC screening before treatment with biologics and repeat it every 6 months could reduce the risk of TBC in IBD patients treated with anti TNF agents.