title: Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents.
abstract: OBJECTIVE
  To evaluate the incidence and risk factors of Korean tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) undergoing anti-TNF treatment.
  
  
  METHODS
  The data of IBD patients treated with anti-TNFs in 13 tertiary referral hospitals located in the southeastern region of Korea were collected retrospectively. They failed to show response or were intolerant to conventional treatments, including steroids or immunomodulators. Screening measures for latent TB infection (LTBI) and the incidence and risk factors of active TB infection after treatment with anti-TNFs were identified.
  
  
  RESULTS
  Overall, 376 IBD patients treated with anti-TNF agents were recruited (male 255, mean age of anti-TNF therapy 32.5 ± 13.0 years); 277 had Crohn's disease, 99 had ulcerative colitis, 294 used infliximab, and 82 used adalimumab. Before anti-TNF treatment, screening tests for LTBI including an interferon gamma release assay or a tuberculin skin test were performed in 82.2% of patients. Thirty patients (8%) had LTBI. Sixteen cases of active TB infection including one TB-related mortality occurred during 801 person-years (PY) follow-up (1997.4 cases per 100000 PY) after anti-TNF treatment. LTBI (OR = 5.76, 95%CI: 1.57-21.20, P = 0.008) and WBC count < 5000 mm(3) (OR = 4.5, 95%CI: 1.51-13.44, P = 0.007) during follow-up were identified as independently associated risk factors.
  
  
  CONCLUSIONS
  Anti-TNFs significantly increase the risk of TB infection in Korean patients with IBD. The considerable burden of TB and marked immunosuppression might be attributed to this risk.
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Eun Soo
authors: ES
authors: Kim
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Geun Am
authors: GA
authors: Song
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Kwang Bum
authors: KB
authors: Cho
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Kyung Sik
authors: KS
authors: Park
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Kyeong Ok
authors: KO
authors: Kim
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Byung Ik
authors: BI
authors: Jang
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Eun Young
authors: EY
authors: Kim
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Seong Woo
authors: SW
authors: Jeon
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Hyun Seok
authors: HS
authors: Lee
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Chang Heon
authors: CH
authors: Yang
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Yong Kook
authors: YK
authors: Lee
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Dong Wook
authors: DW
authors: Lee
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Sung Kook
authors: SK
authors: Kim
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Tae Oh
authors: TO
authors: Kim
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Jonghun
authors: J
authors: Lee
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Hyung Wook
authors: HW
authors: Kim
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Sam Ryong
authors: SR
authors: Jee
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Seun Ja
authors: SJ
authors: Park
authors: Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea.
authors: Hyun Jin
authors: HJ
authors: Kim
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects*; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D000069285:Infliximab / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014376:Tuberculosis / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
keywords: Anti-TNF; Inflammatory bowel disease; Korea; Latent tuberculosis infection; Risk factor; Tuberculosis