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Korean J Gastroenterol  <  Volume 75(1); 2020 <  Articles

Korean J Gastroenterol 2020; 75(1): 29-38  https://doi.org/10.4166/kjg.2020.75.1.29
Clinical Features and Outcomes of Tuberculosis in Inflammatory Bowel Disease Patients Treated with Anti-tumor Necrosis Factor Therapy
Jihye Kim1,2, Jong Pil Im1 , Jae-Joon Yim3, Chang Kyun Lee4, Dong Il Park5, Chang Soo Eun6, Sung-Ae Jung7, Jeong Eun Shin8, Kang-Moon Lee9 and Jae Hee Cheon10
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine1; Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine2; Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine3; Department of Internal Medicine, Kyung Hee University School of Medicine4; Department of Internal Medicine, Sungkyunkwan University School of Medicine5, Seoul; Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine6, Guri; Department of Internal Medicine, Ewha Womans University School of Medicine7, Seoul; Department of Internal Medicine, Dankook University College of Medicine8, Cheonan; Department of Internal Medicine, College of Medicine, The Catholic University of Korea9; Department of Internal Medicine, Yonsei University College of Medicine10, Seoul, Korea
Correspondence to: Jong Pil Im, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-0638, Fax: +82-2-2742-8601, E-mail: jpim0911@snu.ac.kr, ORCID: https://orcid.org/0000-0003-1584-0160
Received: February 2, 2019; Revised: October 1, 2019; Accepted: October 9, 2019; Published online: January 25, 2020.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims: Anti-tumor necrosis factor (TNF) therapy is used widely for the treatment of inflammatory bowel disease (IBD). In the present study, the characteristics and outcomes of tuberculosis (TB) in IBD patients treated with anti-TNF therapy were compared with those of non-IBD TB patients.
Methods: Twenty-five IBD patients who initially developed TB during anti-TNF therapy were enrolled in this study. Seventy-five ageand gender-matched non-IBD TB patients were selected as controls in a 1:3 ratio.
Results: The proportion of non-respiratory symptoms was higher in the IBD patients than in the non-IBD patients (12 [48.0%] in the IBD patients vs. 15 [20.0%] in the non-IBD patients; p=0.009). Eight (32.0%) IBD patients and 19 (25.3%) non-IBD patients had extra- pulmonary lesions (p=0.516). The frequency of positive smear results for acid-fast bacilli (AFB) was significantly higher in the non-IBD patients than in the IBD patients (three [12.0%] IBD patients vs. 27 [36.0%] non-IBD patients; p=0.023). Active TB was cured in 24 (96.0%) patients in the IBD group and in 70 (93.3%) patients in the non-IBD group (p=0.409). The TB-related mortality rates were 4.0% and 1.3% in the IBD patients and non-IBD patients, respectively (p=0.439).
Conclusions: The rate of extrapulmonary involvement, side effects of anti-TB medications, and clinical outcomes did not differ between the IBD patients who initially developed TB during anti-TNF therapy and non-IBD patients with TB. On the other hand, the IBD patients had a lower rate of AFB smear positivity and a higher proportion of non-respiratory symptoms.
Keywords: Tumor necrosis factor inhibitors; Inflammatory bowel diseases; Tuberculosis


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