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P305. Tuberculosis infection in inflammatory bowel disease patients after anti-TNF therapy in a high tuberculosis prevalence rate area

M.L. De Castro1, V. Hernández2, J.R. Pineda2, S. Pereira2, J. Martínez-Cadilla2, L. Sanromán2, I. Rodríguez-Prada2, 1Complejo Hospitalario Universitario de Vigo, Gastroenterology. IBD Unit, Vigo, Spain, 2Complejo Hospitalario Universitario de Vigo, Gastroenterology, Vigo, Spain

Background

Galicia is a region located in the north west of Spain. It has an estimated incidence of 27 new cases of tuberculosis per 100,000 population, that is higher than the Spanish average rate of 15.5/100,000. On the other hand cases of active tuberculosis have been reported worldwide with the use of therapeutic agents that inhibit tumor necrosis factor (TNF) alpha. Our aim was to study the prevalence of latent tuberculosis infection and active tuberculosis in inflammatory bowel disease (IBD) patients before and during TNF therapy in this geographical area.

Methods

We conducted a retrospective study collecting clinica data of IBD patients on anti TNF therapy from January 2000 to December 2012, identifying the cases with latent tuberculosis and active tuberculosis infection.

Latent tuberculosis was defined as a positive tuberculin cutaneous test (TCT) or Booster re-test (>5 mms). Active tuberculosis infection was confirmed by positive culture to Mycobacterium tuberculosis.

Results

225 patients received TNF alpha drugs: 136 male (60.4%), 173 (76.9%) Crohn's disease. No patient had suffered from previous lung diseases. Tuberculin cutaneous test was documented in 190 patients, and Booster re-test in 100. Latent tuberculosis was diagnosed in 20 and 1 patients whether TCT or Booster were >5 mms respectvely and all of them received oral isoniacide prophylaxis (9.3%). Seven patients suffered from active tuberculosis infection (3.1%): 4 male (57.1%) mean age 49.6 years 57.1% ulcerative colitis. Four of them had negative TCT and Booster but they were on inmunosuppresant but no corticosteroids when these tests were performed, and the other 3 patients had received oral quimioprofilaxis (3–6 months) because TCT was positive. Time from last TNF dose to symptoms and from symptoms to tuberculosis diagnose were and days respectively. Active tuberculosis were generally disseminated (85.5%) and required hospitalization until diagnose and clinical stabilization. Multidrug therapy was continued for 6–8 months but one patient eventually died. Anti TNF-alpha was no restarted in these patients.

Conclusion

Active tuberculosis in IBD patients on antiTNF therapy in a high prevalence area was 3.1%. The infection was generally disseminated, required hospitalizations and even caused death.

TCT test and previous oral quimioprofilaxis failed to eliminate risk of active infection in these patients, so any other tests or preventive measures should be develop.