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Challenges in screening for latent tuberculosis in inflammatory bowel disease prior to biologic treatment: a UK cohort study
  1. Aye Aye Thi1,
  2. Aula Abbara2,
  3. Sonia Bouri1,
  4. Simon M Collin3,
  5. Paul Wolfson1,
  6. Leah Owen1,
  7. Kevin G Buell4,
  8. Laurence John2,
  9. Ailsa L Hart1
  1. 1Inflammatory Bowel Disease Unit, St Mark’s Hospital, London, UK
  2. 2Department of Infectious Diseases, Northwick Park Hospital, London, UK
  3. 3Bristol Medical School, University of Bristol, Bristol, UK
  4. 4Department of Primary Care and Public Health, Imperial College London, London, UK
  1. Correspondence to Dr Aye Aye Thi, Inflammatory Bowel Disease Unit, St Mark’s Hospital, London HA1 3UJ, UK; ayeayethi{at}gmail.com

Abstract

Objective The aim of this study was to determine the occurrence of latent tuberculosis infections (LTBI) and active TB in a cohort of patients with inflammatory bowel disease (IBD) treated with biologics. We also examined the effects of immunosuppressive drugs on indeterminate interferon-gamma release assays (IGRA) in LTBI screening.

Design Retrospective study of patients treated with biologics between March 2007 and November 2015.

Setting St Mark’s Hospital, North West London, UK.

Patients 732 patients with IBD who were screened for LTBI using either tuberculin skin test or IGRA before starting a biologic treatment.

Methods Retrospective case note review of all patients with IBD who were screened for LTBI prior to initiating biologics. Patients who developed active TB were identified from the London TB register.

Results Of 732 patients with IBD, 31 (4.2%) were diagnosed with and treated for LTBI with no significant side effects. Six of 596 patients (1.0%) who received biologic treatment developed active TB. There was a higher proportion of indeterminate IGRA in the immunosuppressive medication group compared with the non-immunosuppressive group (33% (59/181) compared with 9% (6/66), p<0.001). The combination of steroids and thiopurines had the highest proportion of indeterminate IGRA (64%, 16/25). High and low doses of steroids were equally likely to result in an indeterminate IGRA result (67% (8/12) and 57% (4/7), respectively).

Conclusions This study highlights the challenges of LTBI screening prior to commencing biologic therapy and demonstrates the risk of TB in patients who have been screened and who are receiving prolonged and continuing doses of antitumour necrosis factor.

  • ibd
  • crohn’s disease
  • ulcerative colitis
  • infliximab

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Footnotes

  • Contributors AAT, LJ and ALH planned and designed the study. AAT, AA, SB, PW, LO and KGB collected and prepared the data. AAT, SMC and AA conducted the analyses. All authors were involved in the interpretation of results, drafting and revision of the manuscript and approved the final version.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data on which this study was based can be made available by the corresponding author to bona fide researchers subject to appropriate ethical approvals.

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