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P124 Latent and active tuberculosis in patients with inflammatory bowel disease under anti-TNF—data from a centre with high incidence of tuberculosis

M. Sousa*1, I. Ladeira1, C. Fernandes1, A. Ponte1, A. Rodrigues1, A. P. Silva1, J. Rodrigues1, J. Silva1, C. Gomes1, J. Carvalho1

1Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal

Background

Portugal is one of the countries with the highest tuberculosis burden in the European Union, with a reporting rate in the North region registered in 2016 of 21.6 cases per 100000 inhabitants. Anti-TNF can increase up to five times the reactivation of tuberculosis in patients with latent infection (LT). Therefore, it is recommended its diagnosis and treatment before starting biological therapies.

Methods

A single-centre retrospective study in the North region of Portugal included patients with inflammatory bowel disease (IBD) who started anti-TNF treatment between 2013 and 2017. The aim was to evaluate the prevalence of LT before initiating anti-TNF and the percentage of active infection during treatment. Screening of LT was considered positive if the tuberculin test (TST) ≥ 5 mm in immunocompromised patients or TST ≥ 10 mm in immunocompetent patients, positive/indeterminate Interferon Gamma Release Test (IGRA) or history of contacts. Active infection was excluded using chest X-ray and clinical history.

Results

One hundred and seventeen patients were identified—56% female, mean age 40 years, 91% Crohn's disease, 9% ulcerative colitis; 79% started infliximab, 21% adalimumab and 1% golimumab. The prevalence of LT was 32% (n = 37)—TST positive in 18 patients (51%); IGRA positive in 14 patients (40%) and undetermined in 7 (6%); history of contacts in 11 patients (31%). During screening 61% of the patients were under immunosuppressive therapy. All patients screened with LT performed isoniazid for 9 months. During follow-up (mean 21.6 months), one patient under infliximab developed pleural tuberculosis 5 years after receiving treatment with isoniazid. None of the patients with negative LT screening had active tuberculosis.

Conclusion

In this sample of patients with IBD, the occurrence of LT before starting biological treatment was significant (32%) but only 1 patient had active tuberculosis after TL treatment.