Cargando…

Active tuberculosis in inflammatory bowel disease patients: a case–control study

BACKGROUND/AIMS: Anti-tumor necrosis factor (anti-TNF) drugs have been the mainstay therapy for moderate to severe inflammatory bowel disease (IBD) over the past 25 years. Nevertheless, these drugs are associated with serious opportunistic infections like tuberculosis (TB). Brazil is ranked among th...

Descripción completa

Detalles Bibliográficos
Autores principales: Freitas Cardoso de Azevedo, Matheus, Barros, Luísa Leite, Fernandes Justus, Filipe, Oba, Jane, Soares Garcia, Karoline, de Almeida Martins, Camilla, de Sousa Carlos, Alexandre, Arruda Leite, André Zonetti, Miranda Sipahi, Aytan, Queiroz, Natália Sousa Freitas, Omar Mourão Cintra Damião, Adérson
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331078/
https://www.ncbi.nlm.nih.gov/pubmed/37435180
http://dx.doi.org/10.1177/17562848231179871
_version_ 1785070186904158208
author Freitas Cardoso de Azevedo, Matheus
Barros, Luísa Leite
Fernandes Justus, Filipe
Oba, Jane
Soares Garcia, Karoline
de Almeida Martins, Camilla
de Sousa Carlos, Alexandre
Arruda Leite, André Zonetti
Miranda Sipahi, Aytan
Queiroz, Natália Sousa Freitas
Omar Mourão Cintra Damião, Adérson
author_facet Freitas Cardoso de Azevedo, Matheus
Barros, Luísa Leite
Fernandes Justus, Filipe
Oba, Jane
Soares Garcia, Karoline
de Almeida Martins, Camilla
de Sousa Carlos, Alexandre
Arruda Leite, André Zonetti
Miranda Sipahi, Aytan
Queiroz, Natália Sousa Freitas
Omar Mourão Cintra Damião, Adérson
author_sort Freitas Cardoso de Azevedo, Matheus
collection PubMed
description BACKGROUND/AIMS: Anti-tumor necrosis factor (anti-TNF) drugs have been the mainstay therapy for moderate to severe inflammatory bowel disease (IBD) over the past 25 years. Nevertheless, these drugs are associated with serious opportunistic infections like tuberculosis (TB). Brazil is ranked among the 30 countries with the highest incidence of TB in the world. This study aimed at identifying risk factors for the development of active TB and describing clinical characteristics and outcomes in IBD patients followed at a tertiary referral center in Brazil. METHODS: We conducted a retrospective, case–control study between January 2010 and December 2021. Active TB cases in IBD patients were randomly matched 1:3 to controls (IBD patients with no previous history of active TB) according to gender, age, and type of IBD. DESIGN: This was a retrospective, case–control study. RESULTS: A total of 38 (2.2%) cases of TB were identified from 1760 patients under regular follow-up at our outpatient clinics. Of the 152 patients included in the analysis (cases and controls), 96 (63.2%) were male, and 124 (81.6%) had Crohn’s disease. Median age at TB diagnosis was 39.5 [interquartile range (IQR) 30.8–56.3]. Half of the active TB cases were disseminated (50%). Overall, 36 patients with TB (94.7%) were being treated with immunosuppressive medications. Of those, 31 (86.1%) were under anti-TNF drugs. Diagnosis of TB occurred at a median of 32 months after the first dose of anti-TNF (IQR 7–84). In multivariate analysis, IBD diagnosis older than 17 years and anti-TNF therapy were significantly associated with the development of TB (p < 0.05). After the TB treatment, 20 (52.7%) patients received anti-TNF therapy, and only one developed ‘de novo’ TB 10 years after the first infection. CONCLUSIONS: TB remains a significant health problem in IBD patients from endemic regions, especially those treated with anti-TNFs. In addition, age at IBD diagnosis (>17 years old) was also a risk factor for active TB. Most cases occur after long-term therapy, suggesting a new infection. The reintroduction of anti-TNFs agents after the anti-TB treatment seems safe. These data highlight the importance of TB screening and monitoring in IBD patients living in endemic areas.
format Online
Article
Text
id pubmed-10331078
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-103310782023-07-11 Active tuberculosis in inflammatory bowel disease patients: a case–control study Freitas Cardoso de Azevedo, Matheus Barros, Luísa Leite Fernandes Justus, Filipe Oba, Jane Soares Garcia, Karoline de Almeida Martins, Camilla de Sousa Carlos, Alexandre Arruda Leite, André Zonetti Miranda Sipahi, Aytan Queiroz, Natália Sousa Freitas Omar Mourão Cintra Damião, Adérson Therap Adv Gastroenterol IBD Barriers Across the Continents BACKGROUND/AIMS: Anti-tumor necrosis factor (anti-TNF) drugs have been the mainstay therapy for moderate to severe inflammatory bowel disease (IBD) over the past 25 years. Nevertheless, these drugs are associated with serious opportunistic infections like tuberculosis (TB). Brazil is ranked among the 30 countries with the highest incidence of TB in the world. This study aimed at identifying risk factors for the development of active TB and describing clinical characteristics and outcomes in IBD patients followed at a tertiary referral center in Brazil. METHODS: We conducted a retrospective, case–control study between January 2010 and December 2021. Active TB cases in IBD patients were randomly matched 1:3 to controls (IBD patients with no previous history of active TB) according to gender, age, and type of IBD. DESIGN: This was a retrospective, case–control study. RESULTS: A total of 38 (2.2%) cases of TB were identified from 1760 patients under regular follow-up at our outpatient clinics. Of the 152 patients included in the analysis (cases and controls), 96 (63.2%) were male, and 124 (81.6%) had Crohn’s disease. Median age at TB diagnosis was 39.5 [interquartile range (IQR) 30.8–56.3]. Half of the active TB cases were disseminated (50%). Overall, 36 patients with TB (94.7%) were being treated with immunosuppressive medications. Of those, 31 (86.1%) were under anti-TNF drugs. Diagnosis of TB occurred at a median of 32 months after the first dose of anti-TNF (IQR 7–84). In multivariate analysis, IBD diagnosis older than 17 years and anti-TNF therapy were significantly associated with the development of TB (p < 0.05). After the TB treatment, 20 (52.7%) patients received anti-TNF therapy, and only one developed ‘de novo’ TB 10 years after the first infection. CONCLUSIONS: TB remains a significant health problem in IBD patients from endemic regions, especially those treated with anti-TNFs. In addition, age at IBD diagnosis (>17 years old) was also a risk factor for active TB. Most cases occur after long-term therapy, suggesting a new infection. The reintroduction of anti-TNFs agents after the anti-TB treatment seems safe. These data highlight the importance of TB screening and monitoring in IBD patients living in endemic areas. SAGE Publications 2023-07-04 /pmc/articles/PMC10331078/ /pubmed/37435180 http://dx.doi.org/10.1177/17562848231179871 Text en © The Author(s), 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle IBD Barriers Across the Continents
Freitas Cardoso de Azevedo, Matheus
Barros, Luísa Leite
Fernandes Justus, Filipe
Oba, Jane
Soares Garcia, Karoline
de Almeida Martins, Camilla
de Sousa Carlos, Alexandre
Arruda Leite, André Zonetti
Miranda Sipahi, Aytan
Queiroz, Natália Sousa Freitas
Omar Mourão Cintra Damião, Adérson
Active tuberculosis in inflammatory bowel disease patients: a case–control study
title Active tuberculosis in inflammatory bowel disease patients: a case–control study
title_full Active tuberculosis in inflammatory bowel disease patients: a case–control study
title_fullStr Active tuberculosis in inflammatory bowel disease patients: a case–control study
title_full_unstemmed Active tuberculosis in inflammatory bowel disease patients: a case–control study
title_short Active tuberculosis in inflammatory bowel disease patients: a case–control study
title_sort active tuberculosis in inflammatory bowel disease patients: a case–control study
topic IBD Barriers Across the Continents
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10331078/
https://www.ncbi.nlm.nih.gov/pubmed/37435180
http://dx.doi.org/10.1177/17562848231179871
work_keys_str_mv AT freitascardosodeazevedomatheus activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT barrosluisaleite activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT fernandesjustusfilipe activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT obajane activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT soaresgarciakaroline activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT dealmeidamartinscamilla activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT desousacarlosalexandre activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT arrudaleiteandrezonetti activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT mirandasipahiaytan activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT queiroznataliasousafreitas activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy
AT omarmouraocintradamiaoaderson activetuberculosisininflammatoryboweldiseasepatientsacasecontrolstudy