title: Negative Screening Does Not Rule Out the Risk of Tuberculosis in Patients with Inflammatory Bowel Disease Undergoing Anti-TNF Treatment: A Descriptive Study on the GETAID Cohort.
abstract: OBJECTIVE
  to describe the characteristics of incident cases of tuberculosis [TB] despite negative TB screening tests, in patients with inflammatory bowel disease [IBD] undergoing anti-TNF treatment, and to identify the risk factors involved.
  
  
  METHODS
  A retrospective descriptive study was conducted at GETAID centers on all IBD patients undergoing anti-TNF treatment who developed TB even though their initial screening test results were negative. The following data were collected using a standardized anonymous questionnaire: IBD, and TB characteristics and evolution, initial screening methods and results, and time before anti-TNF treatment was restarted.
  
  
  RESULTS
  A total of 44 IBD patients [including 23 men; median age 37 years] were identified at 20 French and Swiss centers at which TB screening was performed [before starting anti-TNF treatment] based on Tuberculin Skin Tests [n = 25], Interferon Gamma Release Assays [n = 12], or both [n = 7]. The median interval from the start of anti-TNF treatment to TB diagnosis was 14.5 months (interquartile range [IQR] 25-75: 4.9-43.3). Pulmonary TB involvement was observed in 25 [57%] patients, and 40 [91%] had at least one extrapulmonary location. One TB patient died as the result of cardiac tamponade. Mycobacterium tuberculosis exposure was thought to be a possible cause of TB in 14 cases [32%]: 7 patients [including 6 health care workers] were exposed to occupational risks, and 7 had travelled to endemic countries. Biotherapy was restarted on 27 patients after a median period of 11.2 months [IQR 25-75: 4.4-15.2] after TB diagnosis without any recurrence of the infection.
  
  
  CONCLUSIONS
  Tuberculosis can occur in IBD patients undergoing anti-TNF treatment, even if their initial screening results were negative. In the present population, TB was mostly extrapulmonary and disseminated. TB screening tests should be repeated on people exposed to occupational risks and/or travelers to endemic countries. Restarting anti-TNF treatment seems to be safe.
authors.affiliation: Departement of Hepato-Gastroenterology, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
authors.forename: Yael
authors.initials: Y
authors.lastname: Abitbol
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Haut-Lévêque, Pessac, France.
authors.forename: David
authors.initials: D
authors.lastname: Laharie
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Cosnes
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint Louis, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Allez
authors.affiliation: Department of Hepato-Gastroenterology Hôpital Lyon-Sud, Hospices Civils de Lyon, Lyon, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Nancey
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Mondor, Créteil, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Amiot
authors.affiliation: Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Tours, Tours, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Aubourg
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Nord, Amiens, France.
authors.forename: Mathurin
authors.initials: M
authors.lastname: Fumery
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint-Eloi, Montpellier, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Altwegg
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital La Source-Beaulieu, Lausanne, Suisse.
authors.forename: Pierre
authors.initials: P
authors.lastname: Michetti
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, Paris, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Chanteloup
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Seksik
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint Louis, France.
authors.forename: Clotilde
authors.initials: C
authors.lastname: Baudry
authors.affiliation: Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Nantes, Nantes, France.
authors.forename: Mathurin
authors.initials: M
authors.lastname: Flamant
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Pontchaillou, Rennes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bouguen
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Beaujon, Clichy, France.
authors.forename: Carmen
authors.initials: C
authors.lastname: Stefanescu
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Bourrier
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Hôtel Dieu, Clermont Ferrand, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Bommelaer
authors.affiliation: Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire d'Angers, Angers, France.
authors.forename: Nina
authors.initials: N
authors.lastname: Dib
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital de Brabois, Nancy, France.
authors.forename: Marc André
authors.initials: MA
authors.lastname: Bigard
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Côte de Nacre, Caen, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Viennot
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital de l'Archet, Nice, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Hébuterne
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint Louis, France.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Gornet
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint Antoine, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Marteau
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Beaujon, Clichy, France.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Cochin, Paris, France.
authors.forename: Vered
authors.initials: V
authors.lastname: Abitbol
authors.affiliation: Departement of Hepato-Gastroenterology, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France snahon@ch-montfermeil.fr snahon@club-internet.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Nahon
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000188:drug therapy*; D000069285:Infliximab / Q000627:therapeutic use*; D059425:Interferon-gamma Release Tests; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D000069285:Infliximab; D000068879:Adalimumab
keywords: Crohn’s disease; Inflammatory bowel disease; anti-TNF; screening; tuberculosis; ulcerative colitis