title: The risk of tuberculosis in Korean patients with inflammatory bowel disease receiving tumor necrosis factor-α blockers.
abstract: The aims of this study were to assess the risk of tuberculosis (TB) and the status of latent tuberculosis infection (LTBI) in Korean patients with inflammatory bowel disease (IBD) receiving tumor necrosis factor (TNF)-α blockers. We reviewed medical records of 525 Korean IBD patients (365 TNF-α blocker naïve and 160 TNF-α blocker exposed) between January 2001 and December 2013. The crude incidence of TB was significantly higher in IBD patients receiving TNF-α blockers compared to TNF-α-blocker-naïve patients (3.1% vs. 0.3%, P=0.011). The mean incidence of TB per 1,000 patient-years was 1.84 for the overall IBD population, 4.89 for TNF-α blocker users, and 0.45 for TNF-α-blocker-naïve patients. The adjusted risk ratio of TB in IBD patients receiving TNF-α blocker was 11.7 (95% confidence interval, 1.36-101.3). Pulmonary TB was prevalent in patients treated with TNF-α blockers (80.0%, 4/5). LTBI was diagnosed in 17 (10.6%) patients, and none of the 17 LTBI patients experienced reactivation of TB during treatment with TNF-α blockers. Treatment with TNF-α blockers significantly increased the risk of TB in IBD patients in Korea. De novo pulmonary TB infection was more prevalent than reactivation of LTBI, suggesting an urgent need for specific recommendations regarding TB monitoring during TNF-α blocker therapy.
authors: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea. ; Department of Medicine, Kyung Hee University Graduate School, Seoul, Korea.
authors: Ja Min
authors: 0000-0003-1780-5553
authors: JM
authors: Byun
authors: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
authors: Chang Kyun
authors: 0000-0002-4279-3825
authors: CK
authors: Lee
authors: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
authors: Sang Youl
authors: 0000-0003-0119-5818
authors: SY
authors: Rhee
authors: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
authors: Hyo-Jong
authors: 0000-0002-9675-4557
authors: HJ
authors: Kim
authors: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
authors: Jung-Wook
authors: 0000-0002-5383-7934
authors: JW
authors: Kim
authors: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
authors: Jae-Jun
authors: 0000-0003-2497-8663
authors: JJ
authors: Shim
authors: Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
authors: Jae Young
authors: 0000-0002-7930-1468
authors: JY
authors: Jang
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003424:Crohn Disease / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000069285:Infliximab; D055985:Latent Tuberculosis / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D015122:Mercaptopurine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D056910:Republic of Korea; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; C488629:azathiopurine; D000069285:Infliximab; D015122:Mercaptopurine
keywords: Inflammatory Bowel Disease; Latent Tuberculosis; Tuberculosis; Tumor Necrosis Factor-alpha
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