P502 Different presentation of tuberculosis associated with anti-TNF therapy among patients with Inflammatory Bowel Disease in endemic area: observation from China

Ye, L.(1,2);Wu, L.(3);Tang, J.(4);Mao, R.(5);Cao, Q.(3);

(1)Xiasha Branch of Sir Run Run Shaw Hospital- School of Medicine- Zhejiang University, Department of Gastroenterology, Hangzhou, China;(2)Sir Run Run Shaw Hospital-School of Medicine-Zhejiang University, Inflammatory Bowel Disease Center, Hangzhou, China;(3)Sir Run Run Shaw Hospital- School of Medicine- Zhejiang University, Inflammatory Bowel Disease Center, Hangzhou, China;(4)The Sixth Affiliated Hospital of Sun Yat-sen Universit, Department of Gastroenterology, Guangzhou, China;(5)The First Affiliated Hospital of Sun Yat-sen University, Department of Gastroenterology, Guangzhou, China;


Anti-tumor necrosis factor (TNF) therapy increased the risk of tuberculosis(TB), and the characteristic clinical feature of western patients with inflammatory bowel disease (IBD) receiving anti-TNF therapy were predominantly extrapulmonary TB. We aimed to analyze the clinical features of patients with IBD who in TB-endemic area (China) that developed active tuberculosis after receiving anti-TNF therapy.


Patients from 9 hospital in 7 provinces developed active TB after the initial treatment with infliximab. Demographics, interval between the time at the first dose of anti-TNF therapy and active TB development, tests for latent TB infection (LTBI), concomitant medications, and the details of diagnosis were analyzed in our study. The diagnosis of active TB and LTBI were made based on comprehensive evaluation including TB skin test (TST), interferon gamma releasing assay (IGRA), X-ray test and computed tomography (CT).


Totally 43 patients developed active TB during infliximab therapy. Among 43 patients, 6 patients had a past TB history and 11 patients were confirmed as LTBI before infliximab treatment. Six patients with LTBI received anti-TB prophylaxis as the same time as anti-TNF treatment. The mean time between initiation of infliximab therapy and active tuberculosis diagnosis in patients with LTBI was significantly shorter than patients without LTBI ( 216.9±83.2 days versus 410.9±220.3 days, p=0.042). Among 43 active TB patients, 29 patients (29/43, 67.4%) had isolated pulmonary tuberculosis and 11 patients (11/43, 25.6%) had pulmonary TB concomitantly with other organ involvement. 


IBD patients with LTBI develop TB earlier than those without LTBI during anti-TNF treatment, and history of treatment and anti-TB prophylaxis didn’t fully prevent active TB. The most common disease site is lung in China, most of cases were diagnosed by imaging. Chinese physicians should be aware of the potential for TB development during anti-TNF therapy, especially pulmonary tuberculosis.