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

Area of Science:

• Immunology
• Gastroenterology
• Infectious Diseases

Background:

• Anti-tumor necrosis factor (anti-TNF) therapies are standard for moderate to severe inflammatory bowel disease (IBD).
• Anti-TNF drugs are associated with opportunistic infections, including tuberculosis (TB), a significant concern in endemic regions like Brazil.
• Identifying risk factors for TB in IBD patients on anti-TNF therapy is critical for patient safety.

Purpose of the Study:

• To identify risk factors for developing active TB in IBD patients.
• To describe the clinical characteristics and outcomes of TB in IBD patients treated at a Brazilian tertiary referral center.

Main Methods:

• A retrospective, case-control study was conducted from January 2010 to December 2021.
• Active TB cases in IBD patients were matched 1:3 with controls (IBD patients without a history of active TB) based on gender, age, and IBD type.
• Multivariate analysis was used to determine significant risk factors for TB development.

Main Results:

• 38 cases (2.2%) of active TB were identified among 1760 IBD patients.
• IBD diagnosis at age >17 years and anti-TNF therapy were significantly associated with TB development (p < 0.05).
• Most TB cases (94.7%) occurred in patients on immunosuppressive medication, primarily anti-TNF drugs (86.1%), with diagnosis at a median of 32 months after starting anti-TNF therapy.

Conclusions:

• TB remains a significant threat for IBD patients in TB-endemic areas, particularly those on anti-TNF therapy.
• Older age at IBD diagnosis (>17 years) is an additional risk factor for active TB.
• Reintroducing anti-TNF therapy after TB treatment appears safe, underscoring the need for vigilant TB screening and monitoring in at-risk IBD populations.