Inflammatory bowel disease and mycobacteria: how much can we trust isoniazid prophylaxis during antitumor necrosis factor therapy?


Akyuz F., Cavus B., Iliaz R., Soyer O. M., Ormeci A., Evirgen S., ...Daha Fazla

EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, cilt.31, sa.7, ss.777-780, 2019 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 31 Sayı: 7
  • Basım Tarihi: 2019
  • Doi Numarası: 10.1097/meg.0000000000001403
  • Dergi Adı: EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.777-780
  • Anahtar Kelimeler: antitumor necrosis factor treatment, inflammatory bowel disease, isoniazid chemoprophylaxis, tuberculosis infection, ANTI-TNF IMMUNOTHERAPY, RHEUMATOID-ARTHRITIS, CROHNS-DISEASE, RISK-FACTORS, TUBERCULOSIS, INFLIXIMAB, INFECTION, MECHANISM, TB
  • İstanbul Üniversitesi Adresli: Evet

Özet

Objectives Isoniazid (INH) prophylaxis is recommended for the prevention of tuberculosis (TB) reactivation before or/and during initiation of treatment with tumour necrosis factor antagonists (anti-TNF agents). Nonetheless, the long-term effectiveness of chemoprophylaxis is not clear. In this study, we aimed to evaluate the characteristics of patients who developed TB reactivation in spite of INH prophylaxis associated with anti-TNF treatment. Patients and methods In this retrospective study, medical records of 1263 patients with inflammatory bowel disease were reviewed. Baseline TB screening tests (purified protein derivative test and/or QuantiFERON-TB Gold test) were performed on all patients before initiation of anti-TNF therapy. Patients with purified protein derivative of more than 5 mm and/or a positive result of the QuantiFERON-TB Gold test received INH prophylaxis for 9 months. We analysed the data of patients diagnosed with TB reactivation during the anti-TNF treatment despite INH chemoprophylaxis. Results Overall, 175 patients underwent anti-TNF treatment. Sixty of these 175 patients had pretreatment testing showing latent TB infection and therefore were treated concomitantly with INH for 9 months in addition to their anti-TNF treatment. TB reactivation occurred in four of these 60 co-INH/anti-TNF treated patients. Active TB was diagnosed after 37.5 +/- 27 (range: 18-84) months of anti-TNF treatment. In two of the four patients that active TB was diagnosed, was also detected other Mycobacterium spp.: M. bovis in one patient and M. genavense in the other one. Conclusion INH chemoprophylaxis may not prevent the reactivation of TB during anti-TNF therapy in the long-term. Patients should be carefully and periodically screened for TB reactivation during anti-TNF therapy.