Korean J Gastroenterol.  2020 Jan;75(1):29-38. 10.4166/kjg.2020.75.1.29.

Clinical Features and Outcomes of Tuberculosis in Inflammatory Bowel Disease Patients Treated with Anti-tumor Necrosis Factor Therapy

Affiliations
  • 1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea. jpim0911@snu.ac.kr
  • 2Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
  • 7Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
  • 8Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
  • 9Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 10Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
Anti-tumor necrosis factor (TNF) therapy is used widely for the treatment of inflammatory bowel disease (IBD). In the present study, the characteristics and outcomes of tuberculosis (TB) in IBD patients treated with anti-TNF therapy were compared with those of non-IBD TB patients.
METHODS
Twenty-five IBD patients who initially developed TB during anti-TNF therapy were enrolled in this study. Seventy-five age- and gender-matched non-IBD TB patients were selected as controls in a 1:3 ratio.
RESULTS
The proportion of non-respiratory symptoms was higher in the IBD patients than in the non-IBD patients (12 [48.0%] in the IBD patients vs. 15 [20.0%] in the non-IBD patients; p=0.009). Eight (32.0%) IBD patients and 19 (25.3%) non-IBD patients had extra-pulmonary lesions (p=0.516). The frequency of positive smear results for acid-fast bacilli (AFB) was significantly higher in the non-IBD patients than in the IBD patients (three [12.0%] IBD patients vs. 27 [36.0%] non-IBD patients; p=0.023). Active TB was cured in 24 (96.0%) patients in the IBD group and in 70 (93.3%) patients in the non-IBD group (p=0.409). The TB-related mortality rates were 4.0% and 1.3% in the IBD patients and non-IBD patients, respectively (p=0.439).
CONCLUSIONS
The rate of extrapulmonary involvement, side effects of anti-TB medications, and clinical outcomes did not differ between the IBD patients who initially developed TB during anti-TNF therapy and non-IBD patients with TB. On the other hand, the IBD patients had a lower rate of AFB smear positivity and a higher proportion of non-respiratory symptoms.

Keyword

Tumor necrosis factor inhibitors; Inflammatory bowel diseases; Tuberculosis

MeSH Terms

Hand
Humans
Inflammatory Bowel Diseases*
Mortality
Necrosis*
Tuberculosis*

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