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P482 Selective prophylactic anti-tuberculosis strategy is superior for Chinese patients with inflammatory bowel disease receiving infliximab treatment: a multi-centre retrospective study

L. Ye*1, M. Chen2, X. Gao3, K. Wu4, Z. Ran5, H. Yang6, Z. Liu7, Q. Cao8

1Xiasha Branch of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Gastroenterology, Hangzhou, China, 2The First Affiliated Hospital of Sun Yat-sen University, Gastroenterology, Guangzhou, China, 3The Sixth Affiliated Hospital of Sun Yat-sen University, Gastroenterology, Guangzhou, China, 4Xijing Hospital of The Fourth Military Medical University, Gastroenterology, Xi’an, China, 5Renji Hospital, School of Medicine, Shanghai Jiaotong University, Gastroenterology, Shanghai, China, 6Peking Union Medical College Hospital, Gastroenterology, Beijing, China, 7The Tenth People's Hospital Affiliated to Tongji University, Gastroenterology, Shanghai, China, 8Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Gastroenterology, Hangzhou, China

Background

During anti-TNF therapy, inflammatory bowel disease (IBD) patients either with or without latent tuberculosis infection (LTBI) active TB can develop. It remains unclear whether IBD patients without LTBI receiving prophylactic anti-TB has any clinical value or which prophylactic anti-TB strategy (for both LTBI and non-LTBI or only for LTBI) is superior. Furthermore, the optimum treatment regimen for IBD patients with LTBI receiving infliximab (IFX) in China are both unclear. This study was to investigate the optimal prophylactic anti-TB strategies and treatment regimens in Chinese IBD subjects receiving IFX treatment.

Methods

IBD patients receiving IFX at 18 academic hospitals in China were enrolled. Incidence and risk factors for active TB during IFX treatment were studied. The incidence of active TB in IBD patients with IFX therapy receiving selective (strategy I: only anti-TB prophylaxis for LTBI) and conventional (strategy II: anti-TB prophylaxis for both LTBI and non-LTBI) prophylactic anti-TB strategies was compared. Further subgroup analysis investigated the incidence rate of active TB in LTBI and non-LTBI patients and examined effective prophylactic treatment regimens for LTBI.

Results

A total of 1968 IBD patients receiving IFX treatment were enrolled. The incidence rate of TB was 999.07 per 100000 population per year. At baseline, 166 cases (8.43%) tested positive for LTBI and 1802 cases negative for LTBI prior to IFX treatment. Of 1433 cases receiving strategy I and 483 cases receiving strategy II, 10 and 5 cases developed active TB, respectively.

Figure 1. The incidence of active TB in IBD patients with IFX therapy receiving different strategy.

And the incidence of active TB was not significantly reduced in IBD patients receiving strategy I compared with those receiving strategy II (0.07% vs. 1.04%, p = .67). The incidence of active TB (2.63% vs. 11.54%, p = .048) was significantly reduced but not eradicated in LTBI patients receiving prophylactic anti-TB therapy during IFX treatment, but these findings were not seen in non-LTBI patients.

Figure 2. The incidence of active TB in LTBI and non-LTBI patients.

Furthermore, INH treatment for 6 months significantly decreased the incidence rate of active TB (0% vs. 11.54%, p = 0.045) in LTBI patients.

Conclusion

Selective prophylactic anti-TB strategy may be superior for Chinese patients with IBD receiving IFX treatment and INH treatment for 6 months could be an effective treatment regimen for LTBI.