High Risk Of Tuberculosis During Infliximab Therapy Despite Tuberculosis Screening In Inflammatory Bowel Disease Patients In India

Background/Aims: The data on the risk of tuberculosis (TB) reactivation with inffiximab (IFX) in patients with inflammatory bowel disease (IBD) from TB endemic countries, like India, is limited. The risk of TB reactivation on 1FX and its predictors in patients with IBD was assessed. Methods: This retrospective review included consecutive patients with1BD who received IFX, and were on follow-up from January 2005 to November 2017. The data was recorded on age/disease duration, indications for IFX, screening for latent tuberculosis (LTB) before IFX, response to IFX, incidence and duration when TB developed after IFX, and type of TB (pulmonary [PTB]/extra-pulmonary [EPTB]/disseminated). Results: Of 69 patients (22 ulcerative colitis/47 Crohn's disease; mean age, 35.6 +/- 14.5 years; 50.7% males; median follow-up duration after IFX 19 months [interquartile range, 5.5-48.7 months]), primary non-response at 8 weeks and secondary loss of response at 26 and 52 weeks were seen in 14.5%, 6% and 15% patients respectively. Prior to IFX, all patients were screened for LIB, 8 (11.6%) developed active TB (disseminated, 62.5%; EPTB, 25%; PM, 12.5%) after a median of 19 weeks (interquartile range, 14.0-84.5 weeks) of IFX Of these 8 patients none had LTB, even when 7 of 8 were additionally screened with contrast-enhanced chest tomography. Though not statistically significant, more patients with Crohn's disease than ulcerative colitis (14.9% vs. 4.5%, P=0.21), and those with past history of TB (25% vs. 9.8%, P=0.21), developed TB. Age, gender, disease duration, or extraintestinal manifestations could not predict TB reactivation. Conclusions: There is an extremely high rate of TB with IFX in Indian patients with1BD. Current screening techniques are ineffective and it is difficult to predict TB after IFX.