Risks for opportunistic tuberculosis infection in a cohort of 873 patients with inflammatory bowel disease receiving a tumor necrosis factor-α inhibitor

Ja Min Byun, Chang Kyun Lee, Sang Youl Rhee, Hyo Jong Kim, Jong Pil Im, Dong Il Park, Chang Soo Eun, Sung Ae Jung, Jeong Eun Shin, Kang Moon Lee, JaeHee Cheon

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objective. Real-world epidemiological data on tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) receiving TNF-α inhibitors are scarce. We investigated the risks for and case characteristics of TB in a large cohort of IBD patients treated with TNF-α inhibitors in Korea, where TB is endemic. Materials and methods. We performed an observational study on all TB cases identified in a cohort of 873 IBD subjects treated with TNF-α inhibitors from January 2001 to December 2013. The standardized incidence ratio (SIR) of TB was calculated using data from the matched general population. Results. A total of 25 newly developed TB cases were identified in the cohort (pulmonary TB, 84% [21/25]; extrapulmonary TB, 16% [4/25]). The adjusted SIR of TB was 41.7 (95% confidence interval, 25.3-58.0), compared with that of the matched general population. Nineteen of the 25 patients (76%) developed TB within 2-62 months of initiation of TNF-α inhibitor treatment despite screening negative for latent TB infection (LTBI), whereas three patients with LTBI (12%, 3/25) developed TB 3 months after completion of chemoprophylaxis. The outcomes of TB treatment were mostly favorable, although one death from peritoneal TB was noted. The type of TNF-α inhibitor prescribed (infliximab) was a significant predictor of TB (p = 0.033). Conclusions. TNF-α inhibitor treatment strikingly increases the risk of TB infection in an IBD population from a TB endemic area. Continuous evaluation of the development of de novo TB infection in IBD patients subjected to long-term TNF inhibitor therapy is mandatory.

Original languageEnglish
Pages (from-to)312-320
Number of pages9
JournalScandinavian Journal of Gastroenterology
Volume50
Issue number3
DOIs
Publication statusPublished - 2014 Mar 1

Fingerprint

Opportunistic Infections
Inflammatory Bowel Diseases
Tuberculosis
Tumor Necrosis Factor-alpha
Infection
Tuberculous Peritonitis
Population
Latent Tuberculosis
Incidence
Chemoprevention
Korea
Pulmonary Tuberculosis
Observational Studies

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Byun, Ja Min ; Lee, Chang Kyun ; Rhee, Sang Youl ; Kim, Hyo Jong ; Im, Jong Pil ; Park, Dong Il ; Eun, Chang Soo ; Jung, Sung Ae ; Shin, Jeong Eun ; Lee, Kang Moon ; Cheon, JaeHee. / Risks for opportunistic tuberculosis infection in a cohort of 873 patients with inflammatory bowel disease receiving a tumor necrosis factor-α inhibitor. In: Scandinavian Journal of Gastroenterology. 2014 ; Vol. 50, No. 3. pp. 312-320.
@article{b341b3ccffd34a83903bb41e25d1103e,
title = "Risks for opportunistic tuberculosis infection in a cohort of 873 patients with inflammatory bowel disease receiving a tumor necrosis factor-α inhibitor",
abstract = "Objective. Real-world epidemiological data on tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) receiving TNF-α inhibitors are scarce. We investigated the risks for and case characteristics of TB in a large cohort of IBD patients treated with TNF-α inhibitors in Korea, where TB is endemic. Materials and methods. We performed an observational study on all TB cases identified in a cohort of 873 IBD subjects treated with TNF-α inhibitors from January 2001 to December 2013. The standardized incidence ratio (SIR) of TB was calculated using data from the matched general population. Results. A total of 25 newly developed TB cases were identified in the cohort (pulmonary TB, 84{\%} [21/25]; extrapulmonary TB, 16{\%} [4/25]). The adjusted SIR of TB was 41.7 (95{\%} confidence interval, 25.3-58.0), compared with that of the matched general population. Nineteen of the 25 patients (76{\%}) developed TB within 2-62 months of initiation of TNF-α inhibitor treatment despite screening negative for latent TB infection (LTBI), whereas three patients with LTBI (12{\%}, 3/25) developed TB 3 months after completion of chemoprophylaxis. The outcomes of TB treatment were mostly favorable, although one death from peritoneal TB was noted. The type of TNF-α inhibitor prescribed (infliximab) was a significant predictor of TB (p = 0.033). Conclusions. TNF-α inhibitor treatment strikingly increases the risk of TB infection in an IBD population from a TB endemic area. Continuous evaluation of the development of de novo TB infection in IBD patients subjected to long-term TNF inhibitor therapy is mandatory.",
author = "Byun, {Ja Min} and Lee, {Chang Kyun} and Rhee, {Sang Youl} and Kim, {Hyo Jong} and Im, {Jong Pil} and Park, {Dong Il} and Eun, {Chang Soo} and Jung, {Sung Ae} and Shin, {Jeong Eun} and Lee, {Kang Moon} and JaeHee Cheon",
year = "2014",
month = "3",
day = "1",
doi = "10.3109/00365521.2014.1000960",
language = "English",
volume = "50",
pages = "312--320",
journal = "Scandinavian Journal of Gastroenterology",
issn = "0036-5521",
publisher = "Informa Healthcare",
number = "3",

}

Risks for opportunistic tuberculosis infection in a cohort of 873 patients with inflammatory bowel disease receiving a tumor necrosis factor-α inhibitor. / Byun, Ja Min; Lee, Chang Kyun; Rhee, Sang Youl; Kim, Hyo Jong; Im, Jong Pil; Park, Dong Il; Eun, Chang Soo; Jung, Sung Ae; Shin, Jeong Eun; Lee, Kang Moon; Cheon, JaeHee.

In: Scandinavian Journal of Gastroenterology, Vol. 50, No. 3, 01.03.2014, p. 312-320.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risks for opportunistic tuberculosis infection in a cohort of 873 patients with inflammatory bowel disease receiving a tumor necrosis factor-α inhibitor

AU - Byun, Ja Min

AU - Lee, Chang Kyun

AU - Rhee, Sang Youl

AU - Kim, Hyo Jong

AU - Im, Jong Pil

AU - Park, Dong Il

AU - Eun, Chang Soo

AU - Jung, Sung Ae

AU - Shin, Jeong Eun

AU - Lee, Kang Moon

AU - Cheon, JaeHee

PY - 2014/3/1

Y1 - 2014/3/1

N2 - Objective. Real-world epidemiological data on tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) receiving TNF-α inhibitors are scarce. We investigated the risks for and case characteristics of TB in a large cohort of IBD patients treated with TNF-α inhibitors in Korea, where TB is endemic. Materials and methods. We performed an observational study on all TB cases identified in a cohort of 873 IBD subjects treated with TNF-α inhibitors from January 2001 to December 2013. The standardized incidence ratio (SIR) of TB was calculated using data from the matched general population. Results. A total of 25 newly developed TB cases were identified in the cohort (pulmonary TB, 84% [21/25]; extrapulmonary TB, 16% [4/25]). The adjusted SIR of TB was 41.7 (95% confidence interval, 25.3-58.0), compared with that of the matched general population. Nineteen of the 25 patients (76%) developed TB within 2-62 months of initiation of TNF-α inhibitor treatment despite screening negative for latent TB infection (LTBI), whereas three patients with LTBI (12%, 3/25) developed TB 3 months after completion of chemoprophylaxis. The outcomes of TB treatment were mostly favorable, although one death from peritoneal TB was noted. The type of TNF-α inhibitor prescribed (infliximab) was a significant predictor of TB (p = 0.033). Conclusions. TNF-α inhibitor treatment strikingly increases the risk of TB infection in an IBD population from a TB endemic area. Continuous evaluation of the development of de novo TB infection in IBD patients subjected to long-term TNF inhibitor therapy is mandatory.

AB - Objective. Real-world epidemiological data on tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) receiving TNF-α inhibitors are scarce. We investigated the risks for and case characteristics of TB in a large cohort of IBD patients treated with TNF-α inhibitors in Korea, where TB is endemic. Materials and methods. We performed an observational study on all TB cases identified in a cohort of 873 IBD subjects treated with TNF-α inhibitors from January 2001 to December 2013. The standardized incidence ratio (SIR) of TB was calculated using data from the matched general population. Results. A total of 25 newly developed TB cases were identified in the cohort (pulmonary TB, 84% [21/25]; extrapulmonary TB, 16% [4/25]). The adjusted SIR of TB was 41.7 (95% confidence interval, 25.3-58.0), compared with that of the matched general population. Nineteen of the 25 patients (76%) developed TB within 2-62 months of initiation of TNF-α inhibitor treatment despite screening negative for latent TB infection (LTBI), whereas three patients with LTBI (12%, 3/25) developed TB 3 months after completion of chemoprophylaxis. The outcomes of TB treatment were mostly favorable, although one death from peritoneal TB was noted. The type of TNF-α inhibitor prescribed (infliximab) was a significant predictor of TB (p = 0.033). Conclusions. TNF-α inhibitor treatment strikingly increases the risk of TB infection in an IBD population from a TB endemic area. Continuous evaluation of the development of de novo TB infection in IBD patients subjected to long-term TNF inhibitor therapy is mandatory.

UR - http://www.scopus.com/inward/record.url?scp=84922702492&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922702492&partnerID=8YFLogxK

U2 - 10.3109/00365521.2014.1000960

DO - 10.3109/00365521.2014.1000960

M3 - Article

C2 - 25581784

AN - SCOPUS:84922702492

VL - 50

SP - 312

EP - 320

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

SN - 0036-5521

IS - 3

ER -