Published online Nov 28, 2020. doi: 10.3748/wjg.v26.i44.6993
Peer-review started: July 21, 2020
First decision: October 18, 2020
Revised: November 5, 2020
Accepted: November 14, 2020
Article in press: November 14, 2020
Published online: November 28, 2020
There has been an increase in cases of inflammatory bowel disease (IBD) in recent years. There is also greater access and availability of immunosuppressive and biological agents, which increase the risk of opportunistic infection despite improving the quality of life and promoting mucosal healing. Tuberculosis (TB) remains a public health problem, and it has a high incidence in several countries. Therefore, knowledge of the risk of developing TB in patients with IBD is important.
To evaluate the risk of active TB in patients with IBD under treatment from an endemic area in Latin America.
A standard questionnaire included demographic variables, clinical aspects of IBD disease, history of active TB during treatment, active TB characteristics and evolution, initial screening and results and time from the start of anti-tumor necrosis factor alpha (TNFα) to TB development.
Azathioprine, anti-TNFα and the combination of these two drugs were associated with a higher risk of active TB incidence. The TNFα blockers increased the relative risk of developing active TB compared to other treatments. All four multivariable models showed that the use of TNFα blockers alone or in combination with azathioprine was an important risk factor for the incidence of active TB. After adjustment for sex, age, type of IBD and latent TB, anti-TNFα with azathioprine increased the relative risk to 17.8 times more than conventional treatment. Late TB, which was diagnosed 3 mo after the start of anti-TNFα, was the most frequent.
Treatment with anti-TNFα increased the risk of active TB in IBD patients from an endemic area in Latin America. This risk was increased when anti-TNFα was combined with azathioprine. The time from the beginning of the treatment to the active TB diagnosis suggests a new TB infection.
Core Tip: We evaluated the relative risk of developing active tuberculosis in patients receiving treatment for inflammatory bowel disease. A total of 301 patients with inflammatory bowel disease were evaluated, and an interview was conducted using a standard questionnaire and a review of the medical record. We identified the treatment during the diagnosis of active tuberculosis and the screening and past treatment for latent tuberculosis. Immunosuppressive therapy, specifically azathioprine, anti-tumor necrosis factor alpha (TNFα) and the combination of these two drugs, was associated with an increased risk of active tuberculosis. When adjusted for sex, age, type of inflammatory bowel disease (IBD) and latent tuberculosis, anti-TNFα with azathioprine consistently increased the relative risk to 17.8 times more than conventional treatment. This report is the first study in Latin America to assess the relative risk of developing active tuberculosis in patients with IBD undergoing treatment.