J Korean Med Sci.  2015 Feb;30(2):173-179. 10.3346/jkms.2015.30.2.173.

The Risk of Tuberculosis in Korean Patients with Inflammatory Bowel Disease Receiving Tumor Necrosis Factor-alpha Blockers

• Byun JM
• Lee CK
• Rhee SY
• Kim HJ
• Kim JW
• Shim JJ
• Jang JY

• KMID: 2129648
• DOI: http://doi.org/10.3346/jkms.2015.30.2.173

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)-alpha blockers. We reviewed medical records of 525 Korean IBD patients (365 TNF-alpha blocker naive and 160 TNF-alpha blocker exposed) between January 2001 and December 2013. The crude incidence of TB was significantly higher in IBD patients receiving TNF-alpha blockers compared to TNF-alpha-blocker-naive 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-alpha blocker users, and 0.45 for TNF-alpha-blocker-naive patients. The adjusted risk ratio of TB in IBD patients receiving TNF-alpha blocker was 11.7 (95% confidence interval, 1.36-101.3). Pulmonary TB was prevalent in patients treated with TNF-alpha 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-alpha blockers. Treatment with TNF-alpha 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-alpha blocker therapy.

Keyword

Tuberculosis; Latent Tuberculosis; Tumor Necrosis Factor-alpha; Inflammatory Bowel Disease

MeSH Terms

6-Mercaptopurine/adverse effects/analogs & derivatives/therapeutic use
Adult
Anti-Inflammatory Agents, Non-Steroidal/adverse effects/therapeutic use
Antibodies, Monoclonal/adverse effects/therapeutic use
Cohort Studies
Colitis, Ulcerative/*drug therapy
Crohn Disease/*drug therapy
Female
Humans
Latent Tuberculosis/chemically induced/diagnosis/*epidemiology
Male
Mycobacterium tuberculosis/isolation & purification
Republic of Korea
Retrospective Studies
Tuberculosis, Pulmonary/chemically induced/diagnosis/*epidemiology
Tumor Necrosis Factor-alpha/*antagonists & inhibitors
Anti-Inflammatory Agents, Non-Steroidal
Antibodies, Monoclonal
Tumor Necrosis Factor-alpha

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