Risk and characteristics of tuberculosis after anti-tumor necrosis factor therapy for inflammatory bowel disease: a hospital-based cohort study from Korea

Jae Yong Lee,Sung Wook Hwang,Jeong-Sik Byeon,Seung Wook Hong,Kyunghwan Oh,Hee Seung Hong,Kyung-Wook Jo,Sang Hyoung Park,Seung-Jae Myung,Kyuwon Kim,Suk-Kyun Yang,Byong Duk Ye,Ho-Su Lee,Jin Hwa Park,Dong-Hoon Yang

doi:10.1186/s12876-021-01973-5

Jae Yong Lee, Sung Wook Hwang + Show 13 more

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https://doi.org/10.1186/s12876-021-01973-5

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Abstract

BackgroundAnti-tumor necrosis factor (TNF) treatment for inflammatory bowel disease (IBD) increases the risk of tuberculosis (TB) infection. In the present study, we analyzed the clinical characteristics and risks of TB in Korean patients with IBD who received anti-TNF treatment.MethodsThe study included patients with IBD who were treated using anti-TNF agents between January 2001 and June 2018 at the Asan Medical Center. Overall, 1434 patients with ulcerative colitis or Crohn’s disease were enrolled. We calculated the incidence of active TB infection after anti-TNF treatment and compared the clinical characteristics of the TB group with those of the non-TB group.ResultsTwenty-one patients (1.46%) developed active TB infection, and the incidence rate of active TB was 366.73 per 100,000 person-years. In total, 198 patients (14.9%) were positive for latent tuberculosis infection (LTBI), of whom only eight (4%) did not complete LTBI treatment. The age at which the anti-TNF therapy was started was significantly higher in the TB group than in the non-TB group (HR 1.041, 95% CI 1.014–1.069, p = 0.002), and as age increased, so did the incidence rate of active TB infection (linearity p < 0.001). There was no significant difference in the incidence rate of LTBI between the TB and non-TB groups (HR 0.896, 95% CI 0.262–3.066, p = 0.862).ConclusionsIn patients with IBD, the incidence rate of TB increased with age at anti-TNF therapy initiation. Active treatment of LTBI may lower the incidence of TB in patients with IBD who are to undergo anti-TNF therapy.

Highlights

Anti-tumor necrosis factor (TNF) treatment for inflammatory bowel disease (IBD) increases the risk of tuberculosis (TB) infection
Because anti-TNF therapy increases the risk of active TB development through the reactivation of latent TB [15, 16], guidelines recommend diagnosing and treating latent tuberculosis infection (LTBI) before starting anti-TNF therapy [12, 16, 17]
We identified a significant age difference between the TB group and the non-TB group of patients with IBD (39.57 vs. 31.22 years; p = 0.002), and there was a linear increase in the incidence rate of TB infection as the age at anti-TNF therapy initiation increased (Fig. 2)

Summary

Introduction

Anti-tumor necrosis factor (TNF) treatment for inflammatory bowel disease (IBD) increases the risk of tuberculosis (TB) infection. Immune dysregulation in IBD results in overproduction of tumor necrosis factor (TNF)-α, and monoclonal antibodies targeting TNF-α can suppress the abnormal immune response in IBD [8]. Such anti-TNF therapy has proven effective in both induction and maintenance therapy in patients with IBD, so the use of the anti-TNF therapy is increasing worldwide [9,10,11]. Tuberculosis (TB) is one infection associated with anti-TNF therapy, which is thought to inhibit the formation of granuloma and prevent the suppression of TB activation [14]. The incidence of TB is decreasing worldwide, interest in the disease is increasing in Korea, which still has a higher incidence of TB and LTBI than more developed countries [18,19,20]

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