P829 Tuberculous infection in inflammatory bowel disease patients starting anti-TNF in A Coruña Hospital Area

• Published in: Journal of Crohn's and colitis Vol. 12; no. supplement_1; p. S535
• Main Authors: Diz-Lois Palomares, M T, Del Campo Cano, I, López Álvarez, M, Otero Santiago, M, González Conde, B, Estévez Prieto, E, Alonso Aguirre, P
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 16.01.2018
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjx180.956

Abstract Background It is widely known that anti-TNF treatment can cause tuberculosis (TB) reactivation. TB incidence varies significantly between different countries, and regions. In Spain, Galicia is one of the most prevalent region (20 cases/100000 population in 2014). We have designed this retrospective study to know the prevalence of latent TB infection (LTBI) in our IBD patients starting anti-TNF, to analyse the effectiveness of the preventive measures and the cases of active TB while on anti-TNF treatment. Methods we retrospectively reviewed the medical chart of all the patients with IBD who started and received at least one dose of anti-TNF from March 2012 to January 2017 in A Coruña University Hospital. Results A total of 147 patients started anti-TNF, 55% were men. Median age at IBD diagnosis was 28.7 years. There were 102 CD and 42 UC patients, and 3 patients with unclassified IBD. Median IBD duration was 6.5 years (interquartile range (IQ) 1.8–15.1) in CD and 2.6 years (IQ 1.4–9.6) in UC, p = 0.054. 67% were on immunosuppressive therapy and 56% on corticosteroids. The prevalence of TB infection was 24.4% (CI 95%, 17.7–32.2). Six patients were previously treated (2 active TB, and 4 LTBI). Of the remaining 141 patients, 30 were diagnosed LTBI: 28 with TB skin test (4 booster effect), 1 with IGRAS (implemented from 2016), and 1 case with the chest X ray (chronic changes). LTBI was associated with age: 45.3 years (IQ 41–50) in LTBI patients vs. 34.5 years (IQ 28.8–44.8) in patients without LTBI, p = 0.0006. Prophylactic treatment was made in 19 patients with isoniazid during 6–9 months and in 11 patients with isoniazid plus rifampicin 3 months. It was well tolerated except for one case of hepatotoxicity. Median duration of anti-TNF treatment was 19 months (IQ 10–38). During anti-TNF treatment 5 patients developed active TB. Two were pulmonary TB, in the context of recent bacilliferous contact, 10 and 15 months after starting anti-TNF. The other three patients presented a medianistinal/miliary TB, at 1, 4, and 6 months after starting anti-TNF, these were considered TB reactivation due to anti-TNF. Previous screening results in these five patients: four were previous TB skin test and Booster negative and one had a previous LTBI (and received prophylaxis). Conclusions with TB screening recommendations we observed a prevalence of previous TB infection of infection of 24.4% in patients starting anti-TNF. It was associated with patient age. In spite of the prophylactic measures there were five cases of active TB during anti-TNF treatment, two apparently primo infections and three reactivations, considered failure of screening measures. We must still reinforce the screening of latent TB and be aware of active TB in our patients starting anti-TNF.