Background/Aims Anti-tumor necrosis factor (anti-TNF) drugs have been the mainstay therapy for moderate to severe inflammatory bowel disease (IBD) over the past 25 years. Nevertheless, these drugs are associated with serious opportunistic infections like tuberculosis (TB). Brazil is ranked among the 30 countries with the highest incidence of TB in the world. This study aimed at identifying risk factors for the development of active TB and describing clinical characteristics and outcomes in IBD patients followed at a tertiary referral center in Brazil. Methods We conducted a retrospective, case-control study between January 2010 and December 2021. Active TB cases in IBD patients were randomly matched 1:3 to controls (IBD patients with no previous history of active TB) according to gender, age, and type of IBD. Design This was a retrospective, case-control study. Results A total of 38 (2.2%) cases of TB were identified from 1760 patients under regular follow-up at our outpatient clinics. Of the 152 patients included in the analysis (cases and controls), 96 (63.2%) were male, and 124 (81.6%) had Crohn's disease. Median age at TB diagnosis was 39.5 [interquartile range (IQR) 30.8-56.3]. Half of the active TB cases were disseminated (50%). Overall, 36 patients with TB (94.7%) were being treated with immunosuppressive medications. Of those, 31 (86.1%) were under anti-TNF drugs. Diagnosis of TB occurred at a median of 32 months after the first dose of anti-TNF (IQR 7-84). In multivariate analysis, IBD diagnosis older than 17 years and anti-TNF therapy were significantly associated with the development of TB (p < 0.05). After the TB treatment, 20 (52.7%) patients received anti-TNF therapy, and only one developed 'de novo' TB 10 years after the first infection. Conclusions TB remains a significant health problem in IBD patients from endemic regions, especially those treated with anti-TNFs. In addition, age at IBD diagnosis (>17 years old) was also a risk factor for active TB. Most cases occur after long-term therapy, suggesting a new infection. The reintroduction of anti-TNFs agents after the anti-TB treatment seems safe. These data highlight the importance of TB screening and monitoring in IBD patients living in endemic areas.

中文翻译：

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炎症性肠病患者的活动性结核病：病例对照研究。

背景/目标 过去 25 年来，抗肿瘤坏死因子 (anti-TNF) 药物一直是中度至重度炎症性肠病 (IBD) 的主要治疗方法。然而，这些药物与结核病 (TB) 等严重机会性感染有关。巴西是世界上结核病发病率最高的 30 个国家之一。本研究旨在确定发生活动性结核病的危险因素，并描述巴西三级转诊中心随访的 IBD 患者的临床特征和结果。方法 我们在 2010 年 1 月至 2021 年 12 月期间进行了一项回顾性病例对照研究。根据性别、年龄和 IBD 类型，将 IBD 患者的活动性结核病例与对照（既往无活动性结核病史的 IBD 患者）以 1:3 的比例随机匹配。设计这是一次回顾展，病例对照研究。结果 在我们门诊定期随访的 1760 名患者中，共发现 38 例（2.2%）结核病病例。在分析中纳入的 152 名患者（病例和对照）中，96 名 (63.2%) 为男性，124 名 (81.6%) 患有克罗恩病。结核病诊断时的中位年龄为 39.5 岁 [四分位距 (IQR) 30.8-56.3]。一半的活动性结核病病例发生了传播（50%）。总体而言，36 名结核病患者 (94.7%) 正在接受免疫抑制药物治疗。其中，31 例（86.1%）正在接受抗 TNF 药物治疗。结核病诊断发生在首次注射抗 TNF 药物后平均 32 个月（IQR 7-84）。在多变量分析中，17 岁以上的 IBD 诊断和抗 TNF 治疗与 TB 的发展显着相关（p < 0.05）。结核病治疗后，20（52. 7%）患者接受了抗 TNF 治疗，只有一名患者在第一次感染 10 年后发展为“新发”结核病。结论 结核病仍然是流行地区 IBD 患者的一个重大健康问题，尤其是那些接受抗 TNF 治疗的患者。此外，IBD诊断时的年龄（>17岁）也是活动性结核病的危险因素。大多数病例发生在长期治疗后，表明有新的感染。抗结核治疗后重新使用抗肿瘤坏死因子药物似乎是安全的。这些数据凸显了对生活在流行地区的 IBD 患者进行结核病筛查和监测的重要性。IBD 诊断时的年龄（>17 岁）也是活动性结核病的危险因素。大多数病例发生在长期治疗后，表明有新的感染。抗结核治疗后重新使用抗肿瘤坏死因子药物似乎是安全的。这些数据凸显了对生活在流行地区的 IBD 患者进行结核病筛查和监测的重要性。IBD 诊断时的年龄（>17 岁）也是活动性结核病的危险因素。大多数病例发生在长期治疗后，表明有新的感染。抗结核治疗后重新使用抗肿瘤坏死因子药物似乎是安全的。这些数据凸显了对生活在流行地区的 IBD 患者进行结核病筛查和监测的重要性。