PMID- 33311945 OWN - NLM STAT- MEDLINE DCOM- 20210514 LR - 20210514 IS - 2219-2840 (Electronic) IS - 1007-9327 (Print) IS - 1007-9327 (Linking) VI - 26 IP - 44 DP - 2020 Nov 28 TI - Active tuberculosis in inflammatory bowel disease patients under treatment from an endemic area in Latin America. PG - 6993-7004 LID - 10.3748/wjg.v26.i44.6993 [doi] AB - BACKGROUND: There has been an increase in cases of inflammatory bowel disease (IBD) in recent years. There is also greater access and availability of immunosuppressive and biological agents, which increase the risk of opportunistic infection despite improving the quality of life and promoting mucosal healing. Tuberculosis (TB) remains a public health problem, and it has a high incidence in several countries. Therefore, knowledge of the risk of developing TB in patients with IBD is important. AIM: To evaluate the risk of active TB in patients with IBD under treatment from an endemic area in Latin America. METHODS: A standard questionnaire included demographic variables, clinical aspects of IBD disease, history of active TB during treatment, active TB characteristics and evolution, initial screening and results and time from the start of anti-tumor necrosis factor alpha (TNFalpha) to TB development. RESULTS: Azathioprine, anti-TNFalpha and the combination of these two drugs were associated with a higher risk of active TB incidence. The TNFalpha blockers increased the relative risk of developing active TB compared to other treatments. All four multivariable models showed that the use of TNFalpha blockers alone or in combination with azathioprine was an important risk factor for the incidence of active TB. After adjustment for sex, age, type of IBD and latent TB, anti-TNFalpha with azathioprine increased the relative risk to 17.8 times more than conventional treatment. Late TB, which was diagnosed 3 mo after the start of anti-TNFalpha, was the most frequent. CONCLUSION: Treatment with anti-TNFalpha increased the risk of active TB in IBD patients from an endemic area in Latin America. This risk was increased when anti-TNFalpha was combined with azathioprine. The time from the beginning of the treatment to the active TB diagnosis suggests a new TB infection. CI - (c)The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. FAU - Fortes, Flora Maria Lorenzo AU - Fortes FML AD - Pharmaceutical Sciences Pos-graduation Program, State University of Bahia, Salvador, BA 40460-120, Brazil. FAU - Sorte, Ney Boa AU - Sorte NB AD - Pharmaceutical Sciences Pos-graduation Program, State University of Bahia, Salvador, BA 40460-120, Brazil. FAU - Mariano, Victor D AU - Mariano VD AD - Life Sciences Department, State University of Bahia, Salvador, BA 41150-000, Brazil. FAU - Andrade, Laila D AU - Andrade LD AD - Department of Medicine, FTC University, Salvador, BA 41741-590, Brazil. FAU - Oliveira, Fernanda A AU - Oliveira FA AD - Life Sciences Department, State University of Bahia, Salvador, BA 41150-000, Brazil. FAU - Santos, Monique Ca AU - Santos MC AD - Life Sciences Department, State University of Bahia, Salvador, BA 41150-000, Brazil. FAU - Dos Santos, Claudia Ivanilda N AU - Dos Santos CIN AD - Life Sciences Department, State University of Bahia, Salvador, BA 41150-000, Brazil. FAU - Passos, Catharina A AU - Passos CA AD - Life Sciences Department, State University of Bahia, Salvador, BA 41150-000, Brazil. FAU - Pacheco, Mila P AU - Pacheco MP AD - Pharmaceutical Sciences Pos-graduation Program, State University of Bahia, Salvador, BA 40460-120, Brazil. FAU - Surlo, Valdiana C AU - Surlo VC AD - Outpatient Gastroenterology Unit, General Hospital Roberto Santos, Salvador, BA 40286-901, Brazil. FAU - de Almeida, Neogelia P AU - de Almeida NP AD - Outpatient Gastroenterology Unit, General Hospital Roberto Santos, Salvador, BA 40286-901, Brazil. FAU - Fontes, Jaciane Am AU - Fontes JA AD - Outpatient Gastroenterology Unit, General Hospital Roberto Santos, Salvador, BA 40286-901, Brazil. FAU - Pimentel, Andrea M AU - Pimentel AM AD - Outpatient Gastroenterology Unit, General Hospital Roberto Santos, Salvador, BA 40286-901, Brazil. FAU - Rocha, Raquel AU - Rocha R AD - Department of Sciences of Nutrition, School of Nutrition, Federal University of Bahia, Salvador, BA 41701-035, Brazil. raquelrocha2@yahoo.com.br. FAU - Santana, Genoile Oliveira AU - Santana GO AD - Pharmaceutical Sciences Pos-graduation Program, State University of Bahia, Salvador, BA 40460-120, Brazil. LA - eng PT - Journal Article PL - United States TA - World J Gastroenterol JT - World journal of gastroenterology JID - 100883448 RN - 0 (Tumor Necrosis Factor-alpha) RN - B72HH48FLU (Infliximab) SB - IM MH - Humans MH - *Inflammatory Bowel Diseases/complications/drug therapy/epidemiology MH - Infliximab MH - *Latent Tuberculosis MH - Latin America/epidemiology MH - Quality of Life MH - *Tuberculosis/diagnosis/drug therapy/epidemiology MH - Tumor Necrosis Factor-alpha PMC - PMC7701941 OTO - NOTNLM OT - Inflammatory bowel disease OT - Latent tuberculosis OT - Relative risk OT - Therapy OT - Tuberculosis OT - Tumor necrosis factor alpha COIS- Conflict-of-interest statement: Genoile O Santana: Advisory board-Janssen; Speaker-Abbvie, Ferring, Janssen, Takeda and UCB Pharma; Research-Janssen, Lilly, Pfizer, Roche and Takeda. The other authors declare that they have no conflict of interest. EDAT- 2020/12/15 06:00 MHDA- 2021/05/15 06:00 PMCR- 2020/11/28 CRDT- 2020/12/14 10:54 PHST- 2020/07/21 00:00 [received] PHST- 2020/11/05 00:00 [revised] PHST- 2020/11/14 00:00 [accepted] PHST- 2020/12/14 10:54 [entrez] PHST- 2020/12/15 06:00 [pubmed] PHST- 2021/05/15 06:00 [medline] PHST- 2020/11/28 00:00 [pmc-release] AID - 10.3748/wjg.v26.i44.6993 [doi] PST - ppublish SO - World J Gastroenterol. 2020 Nov 28;26(44):6993-7004. doi: 10.3748/wjg.v26.i44.6993.