Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2015; 21(11): 3308-3316
Published online Mar 21, 2015. doi: 10.3748/wjg.v21.i11.3308
Significant risk and associated factors of active tuberculosis infection in Korean patients with inflammatory bowel disease using anti-TNF agents
Eun Soo Kim, Geun Am Song, Kwang Bum Cho, Kyung Sik Park, Kyeong Ok Kim, Byung Ik Jang, Eun Young Kim, Seong Woo Jeon, Hyun Seok Lee, Chang Heon Yang, Yong Kook Lee, Dong Wook Lee, Sung Kook Kim, Tae Oh Kim, Jonghun Lee, Hyung Wook Kim, Sam Ryong Jee, Seun Ja Park, Hyun Jin Kim
Eun Soo Kim, Kwang Bum Cho, Kyung Sik Park, Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu 700-721, South Korea
Geun Am Song, Hyung Wook Kim, Division of Gastroenterology, Department of Internal Medicine, Pusan National University School of Medicine, Busan 602-739, South Korea
Kyeong Ok Kim, Byung Ik Jang, Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 700-721, South Korea
Eun Young Kim, Dong Wook Lee, Division of Gastroenterology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu 700-721, South Korea
Seong Woo Jeon, Hyun Seok Lee, Sung Kook Kim, Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu 700-721, South Korea
Chang Heon Yang, Yong Kook Lee, Division of Gastroenterology, Department of Internal Medicine, Dongguk University School of Medicine, Gyeongju 780-350, South Korea
Tae Oh Kim, Sam Ryong Jee, Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Busan 602-739, South Korea
Jonghun Lee, Division of Gastroenterology, Department of Internal Medicine, Dong-A University Medical Center, Busan 602-739, South Korea
Seun Ja Park, Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan 602-739, South Korea
Hyun Jin Kim, Division of Gastroenterology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju 660-702, South Korea
Author contributions: Kim ES and Song GA contributed equally to this work; Kim SK and Kim ES designed research; Cho KB, Jang BI, Lee HS, Lee YK, Lee DW, Kim TO, Lee J, Kim HW, Jee SR, Park SJ and Kim HJ collected data; Park KS, Kim KO, Jeon SW, Yang CH and Kim EY analyzed data and were involved in editing the manuscript; Kim ES and Song GA wrote the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sung Kook Kim, MD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, South Korea. dandy090101@naver.com
Telephone: +82-53-2508096 Fax: +82-53-2507088
Received: September 10, 2014
Peer-review started: September 11, 2014
First decision: October 14, 2014
Revised: October 29, 2014
Accepted: December 1, 2014
Article in press: December 1, 2014
Published online: March 21, 2015
Abstract

AIM: To evaluate the incidence and risk factors of Korean tuberculosis (TB) infection in patients with inflammatory bowel disease (IBD) undergoing anti-TNF treatment.

METHODS: The data of IBD patients treated with anti-TNFs in 13 tertiary referral hospitals located in the southeastern region of Korea were collected retrospectively. They failed to show response or were intolerant to conventional treatments, including steroids or immunomodulators. Screening measures for latent TB infection (LTBI) and the incidence and risk factors of active TB infection after treatment with anti-TNFs were identified.

RESULTS: Overall, 376 IBD patients treated with anti-TNF agents were recruited (male 255, mean age of anti-TNF therapy 32.5 ± 13.0 years); 277 had Crohn’s disease, 99 had ulcerative colitis, 294 used infliximab, and 82 used adalimumab. Before anti-TNF treatment, screening tests for LTBI including an interferon gamma release assay or a tuberculin skin test were performed in 82.2% of patients. Thirty patients (8%) had LTBI. Sixteen cases of active TB infection including one TB-related mortality occurred during 801 person-years (PY) follow-up (1997.4 cases per 100000 PY) after anti-TNF treatment. LTBI (OR = 5.76, 95%CI: 1.57-21.20, P = 0.008) and WBC count < 5000 mm3 (OR = 4.5, 95%CI: 1.51-13.44, P = 0.007) during follow-up were identified as independently associated risk factors.

CONCLUSION: Anti-TNFs significantly increase the risk of TB infection in Korean patients with IBD. The considerable burden of TB and marked immunosuppression might be attributed to this risk.

Keywords: Tuberculosis, Anti-TNF, Korea, Inflammatory bowel disease, Latent tuberculosis infection, Risk factor

Core tip: Anti-TNF antagonist therapy implies significant tuberculosis (TB) risk in inflammatory bowel disease (IBD) patients residing in areas with an intermediate burden of TB infection. The risk of susceptibility to TB under anti-TNF treatment is associated with latent TB infection and considerable immunosuppression. Rigorous and sustained assessment of TB infection should be implemented in Korean IBD patients undergoing anti-TNF therapy.