Clinical Features and Outcomes of Tuberculosis in Inflammatory Bowel Disease Patients Treated with Anti-tumor Necrosis Factor Therapy
김지혜, 임종필, 임재준, 이창균, 박동일, 은창수, 정성애, 신정은, 이강문, 천재희,
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김지혜 ( Kim Ji-Hye )
Seoul National University College of Medicine Department of Internal Medicine
임종필 ( Im Jong-Pil )
Seoul National University College of Medicine Department of Internal Medicine
임재준 ( Yim Jae-Joon )
Seoul National University College of Medicine Department of Internal Medicine
이창균 ( Lee Chang-Kyun )
Kyung Hee University School of Medicine Department of Internal Medicine
박동일 ( Park Dong-Il )
Sungkyunkwan University School of Medicine Department of Internal Medicine
은창수 ( Eun Chang-Soo )
Hanyang University College of Medicine Hanyang University Guri Hospital Department of Internal Medicine
정성애 ( Jung Sung-Ae )
Ewha Womans University School of Medicine Department of Internal Medicine
신정은 ( Shin Jeong-Eun )
Dankook University College of Medicine Department of Internal Medicine
이강문 ( Lee Kang-Moon )
Catholic University College of Medicine Department of Internal Medicine
천재희 ( Cheon Jae-Hee )
Yonsei University College of Medicine Department of Internal Medicine
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.
키워드
Tumor necrosis factor inhibitors; Inflammatory bowel diseases; Tuberculosis
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