Journal of Korean Medical Science

  • 제33권47호
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  • Pages.292.1-292.10
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  • 2018
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  • 1011-8934(pISSN)
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  • 1598-6357(eISSN)
대한의학회 (Korean Acad Medical Sciences)
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Incidence of Active Tuberculosis within One Year after Tumor Necrosis Factor Inhibitor Treatment according to Latent Tuberculosis Infection Status in Patients with Inflammatory Bowel Disease

  • Kang, Jieun (Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jeong, Dae Hyun (Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Han, Minkyu (Department of Clinical Epidemiology and Biostatistics, Asan Medical Center) ;
  • Yang, Suk-Kyun (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Byeon, Jeong-Sik (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ye, Byong Duk (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Sang Hyoung (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hwang, Sung Wook (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Shim, Tae Sun (Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jo, Kyung-Wook (Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2018.05.14
  • 심사 : 2018.08.10
  • 발행 : 2018.11.19
⟨ 이전 논문 다음 논문 ⟩

초록

Background: We investigated the incidence of active tuberculosis among patients with inflammatory bowel disease (IBD) treated with tumor necrosis factor (TNF) inhibitors, with or without latent tuberculosis infection (LTBI). Methods: The study was performed at a Korean tertiary referral center between January 2011 and June 2017. In total, 740 patients with IBD who underwent LTBI screening tests and were followed-up for ${\geq}1$ year after TNF inhibitor treatment initiation were enrolled. LTBI was detected on the basis of tuberculin skin test results, interferon-gamma release assay results, chest X-ray findings, and previous tuberculosis treatment history. The patients were classified into LTBI (n = 84) or non-LTBI (n = 656) group. The risk of developing tuberculosis in each group was assessed on the basis of standardized incidence ratio (SIR) and 95% confidence interval (CI) for active tuberculosis. Results: Mean patient age was 33.1 years, and patients with Crohn's disease were predominant (80.7%). Within 1 year after the initiation of TNF inhibitor treatment, 1 patient in the LTBI group (1/84; 1.2%) and 7 patients in the non-LTBI group (7/656; 1.1%) developed active tuberculosis. The overall 1-year incidence of tuberculosis among the patients was significantly higher than that among the general population (SIR, 14.0; 95% CI, 7.0-28.0), and SIR was not affected by LTBI status (LTBI group: 14.5, 95% CI, 2.0-102.6; non-LTBI group: 14.0, 95% CI, 6.7-29.4). Conclusion: Patients with IBD undergoing TNF inhibitor treatment showed a higher 1-year incidence of tuberculosis than the general population irrespective of LTBI status.

키워드

참고문헌

  1. Chung KB, Lee EY, Im JP, Han SK, Yim JJ. Clinical characteristics and treatment responses of patients who developed tuberculosis following use of a tumor necrosis factor-${\alpha}$ inhibitor. Korean J Intern Med 2013;28(2):174-9. https://doi.org/10.3904/kjim.2013.28.2.174
  2. Shim TS. Diagnosis and treatment of latent tuberculosis infection due to initiation of anti-TNF therapy. Tuberc Respir Dis (Seoul) 2014;76(6):261-8. https://doi.org/10.4046/trd.2014.76.6.261
  3. British Thoracic Society Standards of Care Committee. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. Thorax 2005;60(10):800-5. https://doi.org/10.1136/thx.2005.046797
  4. Rampton DS. Preventing TB in patients with Crohn's disease needing infliximab or other anti-TNF therapy. Gut 2005;54(10):1360-2. https://doi.org/10.1136/gut.2005.076034
  5. Carmona L, Gomez-Reino JJ, Rodriguez-Valverde V, Montero D, Pascual-Gomez E, Mola EM, et al. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum 2005;52(6):1766-72. https://doi.org/10.1002/art.21043
  6. Lee EH, Kang YA, Leem AY, Park MS, Kim YS, Kim SK, et al. Active tuberculosis incidence and characteristics in patients treated with tumor necrosis factor antagonists according to latent tuberculosis infection. Sci Rep 2017;7(1):6473. https://doi.org/10.1038/s41598-017-06899-1
  7. Byun JM, Lee CK, Rhee SY, Kim HJ, Kim JW, Shim JJ, et al. The risk of tuberculosis in Korean patients with inflammatory bowel disease receiving tumor necrosis factor-${\alpha}$ blockers. J Korean Med Sci 2015;30(2):173-9. https://doi.org/10.3346/jkms.2015.30.2.173
  8. Lee JW, Choi CH, Park JH, Kim JW, Kang SB, Koo JS, et al. Clinical features of active tuberculosis that developed during anti-tumor necrosis factor therapy in patients with inflammatory bowel disease. Intest Res 2016;14(2):146-51. https://doi.org/10.5217/ir.2016.14.2.146
  9. Jung YJ, Lee JY, Jo KW, Yoo B, Lee CK, Kim YG, et al. The 'either test positive' strategy for latent tuberculous infection before anti-tumour necrosis factor treatment. Int J Tuberc Lung Dis 2014;18(4):428-34. https://doi.org/10.5588/ijtld.13.0644
  10. Kim JH, Yim JJ. Achievements in and challenges of tuberculosis control in South Korea. Emerg Infect Dis 2015;21(11):1913-20. https://doi.org/10.3201/eid2111.141894
  11. Lee SH. Diagnosis and treatment of latent tuberculosis infection. Tuberc Respir Dis (Seoul) 2015;78(2):56-63. https://doi.org/10.4046/trd.2015.78.2.56
  12. Mori T, Sakatani M, Yamagishi F, Takashima T, Kawabe Y, Nagao K, et al. Specific detection of tuberculosis infection: an interferon-gamma-based assay using new antigens. Am J Respir Crit Care Med 2004;170(1):59-64. https://doi.org/10.1164/rccm.200402-179OC
  13. Park SJ, Jo KW, Yoo B, Lee CK, Kim YG, Yang SK, et al. Comparison of LTBI treatment regimens for patients receiving anti-tumour necrosis factor therapy. Int J Tuberc Lung Dis 2015;19(3):342-8. https://doi.org/10.5588/ijtld.14.0554
  14. Galloway JB, Hyrich KL, Mercer LK, Dixon WG, Fu B, Ustianowski AP, et al. Anti-TNF therapy is associated with an increased risk of serious infections in patients with rheumatoid arthritis especially in the first 6 months of treatment: updated results from the British Society for Rheumatology Biologics Register with special emphasis on risks in the elderly. Rheumatology (Oxford) 2011;50(1):124-31. https://doi.org/10.1093/rheumatology/keq242
  15. Scrivo R, Armignacco O. Tuberculosis risk and anti-tumour necrosis factor agents in rheumatoid arthritis: a critical appraisal of national registry data. Int J Rheum Dis 2014;17(7):716-24. https://doi.org/10.1111/1756-185X.12375
  16. Korea Centers for Disease Control and Prevention. Annual report on the notified tuberculosis in Korea 2014. http://tbzero.cdc.go.kr/tbzero/main.do. Updated 2015. Accessed October 30, 2017.
  17. St-Pierre J, Chadee K. How the discovery of TNF-${\alpha}$ has advanced gastrointestinal diseases and treatment regimes. Dig Dis Sci 2014;59(4):712-5. https://doi.org/10.1007/s10620-014-3042-5
  18. Manosa M, Domenech E, Cabre E. Current incidence of active tuberculosis in IBD patients treated with anti-TNF agents: still room for improvement. J Crohns Colitis 2013;7(10):e499-500. https://doi.org/10.1016/j.crohns.2013.04.021
  19. Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 2001;345(15):1098-104. https://doi.org/10.1056/NEJMoa011110
  20. Askling J, Fored CM, Brandt L, Baecklund E, Bertilsson L, Coster L, et al. Risk and case characteristics of tuberculosis in rheumatoid arthritis associated with tumor necrosis factor antagonists in Sweden. Arthritis Rheum 2005;52(7):1986-92. https://doi.org/10.1002/art.21137
  21. Chen DY, Shen GH, Chen YM, Chen HH, Hsieh CW, Lan JL. Biphasic emergence of active tuberculosis in rheumatoid arthritis patients receiving TNF${\alpha}$ inhibitors: the utility of $IFN{\gamma}$ assay. Ann Rheum Dis 2012;71(2):231-7. https://doi.org/10.1136/annrheumdis-2011-200489
  22. Lee SK, Kim SY, Kim EY, Jung JY, Park MS, Kim YS, et al. Mycobacterial infections in patients treated with tumor necrosis factor antagonists in South Korea. Lung 2013;191(5):565-71. https://doi.org/10.1007/s00408-013-9481-5
  23. Sichletidis L, Settas L, Spyratos D, Chloros D, Patakas D. Tuberculosis in patients receiving anti-TNF agents despite chemoprophylaxis. Int J Tuberc Lung Dis 2006;10(10):1127-32.
  24. Parra Ruiz J, Ortego Centeno N, Raya Alvarez E. Development of tuberculosis in a patient treated with infliximab who had received prophylactic therapy with isoniazid. J Rheumatol 2003;30(7):1657-8.
  25. Keane J. TNF-blocking agents and tuberculosis: new drugs illuminate an old topic. Rheumatology (Oxford) 2005;44(6):714-20. https://doi.org/10.1093/rheumatology/keh567
  26. Erkens CG, Slump E, Verhagen M, Schimmel H, de Vries G, Cobelens F, et al. Monitoring latent tuberculosis infection diagnosis and management in the Netherlands. Eur Respir J 2016;47(5):1492-501. https://doi.org/10.1183/13993003.01397-2015
  27. Debeuckelaere C, De Munter P, Van Bleyenbergh P, De Wever W, Van Assche G, Rutgeerts P, et al. Tuberculosis infection following anti-TNF therapy in inflammatory bowel disease, despite negative screening. J Crohns Colitis 2014;8(6):550-7. https://doi.org/10.1016/j.crohns.2013.11.008
  28. Goletti D, Sanduzzi A, Delogu G. Performance of the tuberculin skin test and interferon-${\gamma}$ release assays: an update on the accuracy, cutoff stratification, and new potential immune-based approaches. J Rheumatol Suppl 2014;91:24-31. https://doi.org/10.3899/jrheum.140099
  29. Wong SH, Gao Q, Tsoi KK, Wu WK, Tam LS, Lee N, et al. Effect of immunosuppressive therapy on interferon ${\gamma}$ release assay for latent tuberculosis screening in patients with autoimmune diseases: a systematic review and meta-analysis. Thorax 2016;71(1):64-72. https://doi.org/10.1136/thoraxjnl-2015-207811
  30. Edwards A, Gao Y, Allan RN, Ball D, de Graaf H, Coelho T, et al. Corticosteroids and infliximab impair the performance of interferon-${\gamma}$ release assays used for diagnosis of latent tuberculosis. Thorax 2017;72(10):946-9. https://doi.org/10.1136/thoraxjnl-2016-209397
  31. Pai M, Denkinger CM, Kik SV, Rangaka MX, Zwerling A, Oxlade O, et al. Gamma interferon release assays for detection of Mycobacterium tuberculosis infection. Clin Microbiol Rev 2014;27(1):3-20. https://doi.org/10.1128/CMR.00034-13
  32. Taxonera C, Ponferrada A, Bermejo F, Riestra S, Saro C, Martin-Arranz MD, et al. Early tuberculin skin test for the diagnosis of latent tuberculosis infection in patients with inflammatory bowel disease. J Crohns Colitis 2017;11(7):792-800. https://doi.org/10.1093/ecco-jcc/jjx022
  33. Cantini F, Niccoli L, Goletti D. Adalimumab, etanercept, infliximab, and the risk of tuberculosis: data from clinical trials, national registries, and postmarketing surveillance. J Rheumatol Suppl 2014;91:47-55. https://doi.org/10.3899/jrheum.140102

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