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P497 Clinical features and outcomes of tuberculosis in inflammatory bowel disease patients treated with anti-TNF therapy as compared with the general population

J. Kim*1, J. P. Im1, J.-J. Yim2, C. K. Lee3, D. I. Park4, C. S. Eun5, S.-A. Jung6, J.E. Shin7, K.-M. Lee8, J. H. Cheon9

1Seoul National University College of Medicine, Department of Internal Medicine and Liver Research Institute, Seoul, South Korea, 2Seoul National University College of Medicine, Department of Internal Medicine and Lung Institute, Seoul, South Korea, 3Kyung Hee University School of Medicine, Department of Internal Medicine, Seoul, South Korea, 4Sungkyunkwan University School of Medicine, Department of Internal Medicine, Seoul, South Korea, 5Hanyang University, Department of Internal Medicine, Guri, South Korea, 6Ewha Woman’s University School of Medicine, Department of Internal Medicine, Seoul, South Korea, 7Dankook University College of Medicine, Department of Internal Medicine, Cheonan, South Korea, 8The Catholic University of Korea College of Medicine, Department of Internal Medicine, Seoul, South Korea, 9Yonsei University College of Medicine, Department of Internal Medicine, Seoul, South Korea

Background

Introduction of an anti-tumour necrosis factor (TNF) therapy has altered the treatment strategy for inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn’s disease (CD). Anti-TNF therapy is associated with increased risk of tuberculosis (TB) infection by blocking the TNF action, which has an important role in suppressing mycobacterial infection. However, there are no previous studies comparing TB in IBD patients with the general population. We compared the characteristics and outcomes of TB in IBD patients who have had active TB during anti-TNF therapy and patients from the general population.

Methods

In total, 23 IBD patients who have initially developed TB during anti-TNF therapy from January 2001 to December 2013 at 8 academic teaching hospitals of Korea were included. To compare TB in IBD patients receiving anti-TNF therapy with patients from the general population, we performed a nested case-control analysis within the cohort. Each patient was matched by age, gender with 3 controls selected from non-IBD patients with TB.

Results

Amongst the IBD patients with TB, 22 (95.7%) patients were treated with infliximab and 1 (4.3%) patient with both infliximab and adalizumab. The 3 IBD patients receiving anti-TNF therapy had extrapulmonary TB. However, the rate of extrapulmonary TB in the IBD patients receiving anti-TNF therapy did not differ from that observed in the non-IBD patients (3 [13.0%] IBD patients vs 16 [23.2%] non-IBD patients; p = 0.298). Rates of toxicity associated with anti-TB therapy were 4.3% in IBD patients (one patients) and 18.8% (13 patients) in non-IBD patients (p = 0.094). TB-related mortality rates in both groups was 4.3% (1 (4.3%) IBD patients vs 3 (4.3%) non-IBD TB patients; p = 1.00). Positive sputum AFB smear were less frequent amongst IBD patients (3 [13%] IBD patients vs 27 [39.1%] non-IBD patients; p = 0.021). Biopsies for diagnosis were less often required in IBD patients (4 [17.4%]) vs 28 [17%] non-IBD patients; p = 0.043).

Conclusion

In this study, IBD patients who have initially developed TB during anti-TNF therapy did not differ from the non-IBD patients with TB in terms of the rate of extrapulmonary TB, side effects of anti-TB medications or outcomes of TB treatment. However, they did exhibit a fewer sputum AFB smear positivity and a lower incidence of biopsy for diagnosis. Although anti-TNF therapy may increase the risk of TB infection, physician should not hesitate to recommend anti-TNF therapy for patient with IBD.