Tuberculosis in Anti-Tumour Necrosis Factor-treated Inflammatory Bowel Disease Patients After the Implementation of Preventive Measures: Compliance With Recommendations and Safety of Retreatment

Abstract

Tuberculosis could still occur in anti-TNF-treated IBD patients despite compliance with recommended preventive measures. A significant number of cases developed when these recommendations were not followed. Restarting anti-TNF treatment in these patients seems to be safe.

Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 2: management

“… 1 For these reasons, screening and treatment for LTBI before initiating anti-TNF therapy are strongly recommended by many scientific organizations and health authorities worldwide. 6 7 8 9 10 11 12 13 14 15 16 17 18 19…”

“…In a multicenter, retrospective study from Spain, 60% (30/50) of TB cases in anti-TNF-treated patients with IBD developed TB despite properly following the national guidelines for LTBI treatment, including 5 patients who received LTBI chemoprophylaxis. 13 In a retrospective observational study from Greece, of 36 patients who completed LTBI treatment prior to anti-TNF therapy, 7 developed active TB at 2 to 35 months after anti-TNF therapy initiation. 40 In a retrospective observational study from South Korea, the active TB incidence was 1,107 per 100,000 patient-years in LTBI-positive anti-TNF users who received standard LTBI treatment and 490 per 100,000 patient-years in LTBI-negative anti-TNF users.…”

“…The development of active TB cannot be completely prevented during anti-TNF therapy despite LTBI treatment owing to the reactivation of LTBI caused by incomplete TB eradication with the currently recommended regimens and the risk of new infections resulting from close contact with infectious patients with TB in countries with a high prevalence of TB, even after the successful eradication of LTBI. 13 36 39 40 41 Occasionally, active TB can be detected as an incidental finding on a chest radiograph during a regular check-up in asymptomatic patients. For this reason, the development of TB during anti-TNF therapy should carefully be monitored.…”

Risk of incident Mycobacterium tuberculosis infection in patients with inflammatory bowel disease: a nationwide population‐based study in South Korea

“…In this way, the risk of incident TB has been reduced substantially . Nonetheless, this strategy fails to completely eliminate the risk of TB after anti‐TNF‐α therapy . Moreover, one study indicated that active TB was more common in patients with IBDs even before anti‐TNF‐α treatment was started …”

“…[5][6][7] Nonetheless, this strategy fails to completely eliminate the risk of TB after anti-TNF-a therapy. 8 Moreover, one study indicated that active TB was more common in patients with IBDs even before anti-TNF-a treatment was started. 9 Only a few studies have evaluated the risk of incident active TB in patients with IBDs.…”