title: 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: OBJECTIVE
  Despite having adopted preventive measures, tuberculosis (TB) may still occur in patients with inflammatory bowel disease (IBD) treated with anti-tumour necrosis factor (anti-TNF). Data on the causes and characteristics of TB cases in this scenario are lacking. Our aim was to describe the characteristics of TB in anti-TNF-treated IBD patients after the publication of the Spanish TB prevention guidelines in IBD patients and to evaluate the safety of restarting anti-TNF after a TB diagnosis.
  
  
  METHODS
  In this multicentre, retrospective, descriptive study, TB cases from Spanish hospitals were collected. Continuous variables were reported as mean and standard deviation or median and interquartile range. Categorical variables were described as absolute and relative frequencies and their confidence intervals when necessary.
  
  
  RESULTS
  We collected 50 TB cases in anti-TNF-treated IBD patients, 60% male, median age 37.3 years (interquartile range [IQR] 30.4-47). Median latency between anti-TNF initiation and first TB symptoms was 155.5 days (IQR 88-301); 34% of TB cases were disseminated and 26% extrapulmonary. In 30 patients (60%), TB cases developed despite compliance with recommended preventive measures; *not performing 2-step TST (tuberculin skin test) was the main failure in compliance with recommendations. In 17 patients (34%) anti-TNF was restarted after a median of 13 months (IQR 7.1-17.3) and there were no cases of TB reactivation.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Complexo Hospitalario Universitario de Pontevedra. Instituto de Investigación Biomédica Galicia Sur (IBI), Spain daniel.carpio.lopez@sergas.es.
authors.forename: D
authors.initials: D
authors.lastname: Carpio
authors.affiliation: Hospital Clinic i Provincial, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Jauregui-Amezaga
authors.affiliation: Hospital Central de Asturias, Oviedo, Spain.
authors.forename: R
authors.initials: R
authors.lastname: de Francisco
authors.affiliation: Complexo Hospitalario Universitario, Vigo, Spain.
authors.forename: L
authors.initials: L
authors.lastname: de Castro
authors.affiliation: Complexo Hospitalario Universitario, Santiago de Compostela, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Barreiro-de Acosta
authors.affiliation: Hospital Clínico, Madrid, Spain.
authors.forename: J L
authors.initials: JL
authors.lastname: Mendoza
authors.affiliation: Hospital de Badalona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Mañosa
authors.affiliation: Hospital Universitario Arquitecto Marcide, Ferrol, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Ollero
authors.affiliation: Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Castro
authors.affiliation: Complexo Universitario Juan Canalejo, A Coruña, Spain.
authors.forename: B
authors.initials: B
authors.lastname: González-Conde
authors.affiliation: Hospital Virgen de Altagracia, Manzanares, Ciudad Real, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Hervías
authors.affiliation: Complejo Hospitalario, León, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sierra Ausin
authors.affiliation: Hospital Rio Hortega, Valladolid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Sancho Del Val
authors.affiliation: Hospital Infanta Cristina de Parla, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Botella-Mateu
authors.affiliation: Complexo Hospitalario Universitario, Vigo, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Martínez-Cadilla
authors.affiliation: Clínica Puerta de Hierro, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Calvo
authors.affiliation: Servicio de Aparato Digestivo, Hospital Universitario de La Princesa e Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Chaparro
authors.affiliation: Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Ginard
authors.affiliation: Hospital de Fuenlabrada, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Guerra
authors.affiliation: Hospital de Manises, Valencia, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Maroto
authors.affiliation: Institut Universitàri Parc Taulí, Sabadell, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Calvet
authors.affiliation: Complexo Hospitalario Universitario de Pontevedra. Instituto de Investigación Biomédica Galicia Sur (IBI), Spain.
authors.forename: E
authors.initials: E
authors.lastname: Fernández-Salgado
authors.affiliation: Hospital Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Gordillo
authors.affiliation: Hospital de Valme, Sevilla, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Rojas Feria
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy*; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D019233:Retreatment; D012189:Retrospective Studies; D013030:Spain; D016896:Treatment Outcome; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D007166:Immunosuppressive Agents; D000069285:Infliximab; D000068879:Adalimumab
keywords: Anti-TNF; Crohn’s disease; adalimumab; inflammatory bowel disease; infliximab; prevention; retreatment; tuberculosis; ulcerative colitis