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* = Presenting author

P554 A negative screening does not eliminate tuberculosis risk under anti-TNF treatment in inflammatory bowel disease: a descriptive study

Y. Abitbol*1, D. Laharie2, J. Cosnes3, M. Allez4, S. Nancey5, A. Amiot6, A. Aubourg7, M. Fumery8, R. Altwegg9, P. Michetti10, E. Chanteloup11, P. Seksik3, V. Abitbol12, C. Baudry4, M. Flamant13, G. Bouguen14, C. Stefanescu15, A. Bourrier3, G. Bommelaer16, N. Dib17, M.A. Bigard18, S. Viennot19, X. Hébuterne20, J.M. Gornet4, P. Marteau21, Y. Bouhnik15, S. Nahon1

1Groupe hospitalier de Montfermeil, Montfermeil, France, 2Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France, 3Hôpital Saint-Antoine, Paris, France, 4Hôpital Saint-Louis, Paris, France, 5Centre Hospitalier Universitaire de Lyon, Lyon, France, 6Centre Hospitalier Universitaire Mondor, Créteil, France, 7Centre Hospitalier Universitaire de Tours, Tours, France, 8Hôpital Nord d’Amiens, Amiens, France, 9Hôpital Saint-Eloi, Montpellier, France, 10La source-Beaulieu, Lausanne, Switzerland, 11Hôpital Saint-Joseph, Paris, France, 12Hopital Cochin, Paris, France, 13Centre Hospitalier Universitaire de Nantes, Nantes, France, 14Centre Hospitalier Universitaire et Régionales Pontchaillou, Rennes, France, 15Hôpital Beaujon, Clichy, France, 16Hôpital Hôtel Dieu, Clermont Ferrand, France, 17Centre Hospitalier Universitaire de Angers, Angers, France, 18Hôpital de Brabois, Nancy, France, 19Hôpital Côte de Nacre, Caen, France, 20Hôpital de l’Archet, Nice, France, 21Hôpital Lariboisière, Paris, France

Background

Tuberculosis (TB) screening is required before starting anti-TNF treatment. Screening is based on tuberculin skin test (TST) or IGRA (Interferon-γ release assays) test and a chest X-ray. The aims of this study were to describe characteristics of TB cases under anti-TNF treatment despite a negative screening in patients with inflammatory bowel diseases (IBD), and to identify risk factors.

Methods

Retrospective descriptive study conducted in GETAID centres. All patients with IBD and tuberculosis under anti-TNF, despite a negative initial screening (TST and/or IGRA test with chest X-ray) were included. The following data were collected through a standardised anonymous questionnaire (FileMaker Pro 13®): IBD and TB characteristics and evolution, initial screening modalities and results, and modality of restart anti-TNF.

Results

Data from 44 patients (23 men and 21 women with median age 37 years [IQR 25–75, 25–46)] were recorded in 22 centres; 36 had Crohn’s disease and 8 ulcerative colitis. Each patient had TB-negative screening before starting anti-TNF: TST (n = 25), IGRA test (n = 12), or both (n = 7). The median time between TB diagnosis and the beginning of anti-TNF was 434 days (IQR 25–75, 148–1 298). Four (9%) patients had only a pulmonary TB. Forty (91%) patients had at least 1 extra-pulmonary involvement (23 lymph-node, 11 pleural, and 6 peritoneal diseases) isolated in 19 cases, and with pulmonary involvement in 21 cases. A patient died from TB pericarditis complicated by a cardiac tamponade. When TB was diagnosed, anti-TNF was stopped, and anti-TB therapy was started. Mycobacterium tuberculosis exposure was considered as possible in 16 cases (36%): 7 patients had an at-risk profession (including 6 health care workers), and 9 travelled in an endemic country. Further, 23 (52%) patients restarted anti-TNF; 3 vedolizumab; and 1 ustekinumab, after a median time of 336 days (IQR 25–75, 131–455) after TB diagnosis. No TB recurrence was observed after a median time of 1 013 days (IQR 25–75, 398–2 134).

Conclusion

This study confirms that TB may occur despite a negative initial screening in patients with IBD treated by anti-TNF. TB was mostly extra-pulmonary and disseminated. Having an at-risk profession and/or travelling in an endemic country could lead to repeat TB screening tests.