title: Risks for opportunistic tuberculosis infection in a cohort of 873 patients with inflammatory bowel disease receiving a tumor necrosis factor-α inhibitor.
abstract: OBJECTIVE
  Real-world epidemiological data on tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) receiving TNF-α inhibitors are scarce. We investigated the risks for and case characteristics of TB in a large cohort of IBD patients treated with TNF-α inhibitors in Korea, where TB is endemic.
  
  
  METHODS
  We performed an observational study on all TB cases identified in a cohort of 873 IBD subjects treated with TNF-α inhibitors from January 2001 to December 2013. The standardized incidence ratio (SIR) of TB was calculated using data from the matched general population.
  
  
  RESULTS
  A total of 25 newly developed TB cases were identified in the cohort (pulmonary TB, 84% [21/25]; extrapulmonary TB, 16% [4/25]). The adjusted SIR of TB was 41.7 (95% confidence interval, 25.3-58.0), compared with that of the matched general population. Nineteen of the 25 patients (76%) developed TB within 2-62 months of initiation of TNF-α inhibitor treatment despite screening negative for latent TB infection (LTBI), whereas three patients with LTBI (12%, 3/25) developed TB 3 months after completion of chemoprophylaxis. The outcomes of TB treatment were mostly favorable, although one death from peritoneal TB was noted. The type of TNF-α inhibitor prescribed (infliximab) was a significant predictor of TB (p = 0.033).
  
  
  CONCLUSIONS
  TNF-α inhibitor treatment strikingly increases the risk of TB infection in an IBD population from a TB endemic area. Continuous evaluation of the development of de novo TB infection in IBD patients subjected to long-term TNF inhibitor therapy is mandatory.
authors.affiliation: Department of Internal Medicine, Kyung Hee University School of Medicine , Seoul , Korea.
authors.forename: Ja Min
authors.initials: JM
authors.lastname: Byun
authors.forename: Chang Kyun
authors.initials: CK
authors.lastname: Lee
authors.forename: Sang Youl
authors.initials: SY
authors.lastname: Rhee
authors.forename: Hyo-Jong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Jong Pil
authors.initials: JP
authors.lastname: Im
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Park
authors.forename: Chang Soo
authors.initials: CS
authors.lastname: Eun
authors.forename: Sung-Ae
authors.initials: SA
authors.lastname: Jung
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Shin
authors.forename: Kang-Moon
authors.initials: KM
authors.lastname: Lee
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cheon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000453:epidemiology*; D000069285:Infliximab; D055985:Latent Tuberculosis / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
keywords: inflammatory bowel disease; latent tuberculosis infection; tuberculosis; tumor necrosis factor-α inhibitor