| Description: |
Background In the last, 20 years, IBD treatment has made great progress with the implementation of biological drugs. Although the use of anti-tumor necrosis factor-alpha (anti-TNF-α) agents is highly effective in achieving and maintaining remission, 1, anti-TNF-α agents are associated with a, 5-fold increased risk of reactivation of various opportunistic infections, including TBI, 2,3. Our study aims to determine the incidence of TBI (active tuberculosis (ATBI) and latent tuberculosis (LTBI)) among patients with Crohn’s disease (CD) receiving anti-TNF-α therapy. Methods For the period between June, 2010 to December, 2019, we performed a retrospective analysis of a total of, 109 CD patients, screened before the start of biological treatment. Anti-TNF-α therapy was initiated by, 97 patients, 74 of whom were retested for TBI during follow-up. All patients were BCG vaccinated. Results Before starting biological treatment, we etablished LTBI in, 11/109 (10.1%):, 8/11 (72.7%) patients were TST (+) alone, 2/11 (18.2%) were IGRA (+) and TST (-), 1/11 (9.1%) were both IGRA and TST (+). Chest x-ray abnormalities were not detected in all, 11 patients. After prophylaxis with isoniazid (INH), 300 mg / daily for, 9 months, 9/11 (83.3%) patients with LTBI reached treatment with an anti-TNF α agent. Of this group, 7/9 (77.8%) patients were retested for TBI:, 6/7 (85,7%) were TST and IGRA were (-), and one (14,3%) developed active pulmonary tuberculosis. Two patients were lost to follow up. In the follow-up of patients under anti-TNF-α therapy, 74/97 (76.3%) patients were retested for TBI, with median duration of anti-TNF-a therapy was, 24 (IQR, 6–90) months. A total of, 16/74 (21.6%) patients were newly diagnosed with LTBI:, 5/16 (31.3%) had TST conversion alone, 8/16 (50.0%) were TST(+) and IGRA (-), 1/16, 6.3%) were both TST and IGRA (+), 1/16 (6.3%) had IGRA conversion alone, 1/16 (6.3%) were TST (-) and IGRA (+). ATBI developed in, 3/74 (4.1%) patients, one of them on the background of chemoprophylaxis with INH for ... |