P598 Tuberculosis infection in IBD patients on antitnf therapy: an Algerian retrospective study
H. Saoula*1, A. Boutaleb1, T. Bouchelghoum1, N. Ait Hamadouche1, Y. Zmiri1, F. Chemanedji1, M. Aissaoui1, R. Osmane1, D. Hamidouche1, A. Salah1, L. Malaoui1, L. Gamar2, L. Kecili2, N. Bounab2, K. Belhocine2, W. Menni3, N. Kaddache2, F. Yahiaoui3, A. Bousseloub3, N. Zighmi4, T. Hammada4, M. Amar5, C. Hakem5, L. Benahmed5, C. Mamouni5, H. Bouasria5, D. Titsaoui6, T. Douidi6, T. Djadel6, F. Dib7, F. Lounes8, P. Ouldgougam8, S. Cheraitia8, O. Louahadj8, M. Lahcene8, C. Belghazi4, H. Mahiou1, M. Kassama4, T. Boucekkine2, S. Berkane2, M. Nakmouche1
1CHU of Bab El Oued, Gastroenterology, Algiers, Algeria, 2CHU Mustapha, Gastroenterology, Algiers, Algeria, 3HCA, Gastroenterology, Algiers, Algeria, 4CHU Constantine, Gastroenterology, Constantine, Algeria, 5CHU Oran, Gastroenterology, Oran, Algeria, 6CHU Belabbes, Gastroenterology, Belabbes, Algeria, 7CHU Tlemcen, Gastroenterology, Tlemcen, Algeria, 8CHU Bainem, Gastroenterology, Algiers, Algeria
Algeria is a country considered as a high prevalence area of tuberculosis .
Our aim was to study the prevalence of latent tuberculosis infection and active tuberculosis in inflammatory bowel disease (IBD) patients before and during antiTNF therapy
. We conducted a retrospective study in 7 centers, collecting clinical data of IBD patients on anti TNF therapy (Infliximab or Adalimumab) from November 2010 to July 2014, identifying the cases with latent tuberculosis (LTB) and active tuberculosis infection.
214 patients received antitnf therapy ; 117 ( 54.7%) male ;177 (82.7%) crohn disease and 37 (17.3%)ulcerative colitis ;the mean age at introduction of antitnf therapy was 35.24( ±11.54 range16 --73 ), 131(61.2%) patients were on concomitant immunosuppressive treatment ;the mean duration of antitnf therapy was 48.53 ± 38.36 weeks (range 2 -182) . In the screening procedure, X-ray was performed in 87.85%, tuberculin skin tests (TST) in 79% and an interferon-gamma release assays (IGRA) test in 82% of patients. Based on the screening, LTB was found in 28 (13.1%) patients .All patients with positive screening for LTB received prophylactic treatment for 6 months.
Active tuberculosis infection occurred in 4 (1.86%) male patients , all with crohn disease, mean age 30.2 years.2patients have been treated for 6 months for latent tuberculosis,the two others were negative on initial screening .Tuberculosis infection appeared 6,19,52 and 67 weeks after starting antitnf therapy.
The localization of tuberculosis was peritoneal in one, pulmonary in one, and disseminated in two patients. They all received therapy and resolved,antitnf was definitively stopped in these patients.
Active tuberculosis in IBD patients on antiTNF therapy in a high prevalence area was 1.86%, this infection occurred despite screening and previous oral prophylactic treatment.
These cases highlight the need for periodical assessment and follow up of our patients.