Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
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Incidence of Active Tuberculosis within One Year after Tumor Necrosis Factor Inhibitor Treatment according to Latent Tuberculosis Infection Status in Patients with Inflammatory Bowel Disease

  • Kang, Jieun (Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jeong, Dae Hyun (Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Han, Minkyu (Department of Clinical Epidemiology and Biostatistics, Asan Medical Center) ;
  • Yang, Suk-Kyun (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Byeon, Jeong-Sik (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ye, Byong Duk (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Sang Hyoung (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hwang, Sung Wook (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae Sun (Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jo, Kyung-Wook (Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2018.05.14
  • Accepted : 2018.08.10
  • Published : 2018.11.19
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Abstract

Background: We investigated the incidence of active tuberculosis among patients with inflammatory bowel disease (IBD) treated with tumor necrosis factor (TNF) inhibitors, with or without latent tuberculosis infection (LTBI). Methods: The study was performed at a Korean tertiary referral center between January 2011 and June 2017. In total, 740 patients with IBD who underwent LTBI screening tests and were followed-up for ${\geq}1$ year after TNF inhibitor treatment initiation were enrolled. LTBI was detected on the basis of tuberculin skin test results, interferon-gamma release assay results, chest X-ray findings, and previous tuberculosis treatment history. The patients were classified into LTBI (n = 84) or non-LTBI (n = 656) group. The risk of developing tuberculosis in each group was assessed on the basis of standardized incidence ratio (SIR) and 95% confidence interval (CI) for active tuberculosis. Results: Mean patient age was 33.1 years, and patients with Crohn's disease were predominant (80.7%). Within 1 year after the initiation of TNF inhibitor treatment, 1 patient in the LTBI group (1/84; 1.2%) and 7 patients in the non-LTBI group (7/656; 1.1%) developed active tuberculosis. The overall 1-year incidence of tuberculosis among the patients was significantly higher than that among the general population (SIR, 14.0; 95% CI, 7.0-28.0), and SIR was not affected by LTBI status (LTBI group: 14.5, 95% CI, 2.0-102.6; non-LTBI group: 14.0, 95% CI, 6.7-29.4). Conclusion: Patients with IBD undergoing TNF inhibitor treatment showed a higher 1-year incidence of tuberculosis than the general population irrespective of LTBI status.

Keywords

References

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