P0851 Managing tuberculosis infection risk in inflammatory bowel disease patients before biological therapy initiation – Single-center experience

Abstract Background Ulcerative colitis (UC) and Crohn’s disease (CD) represent distinct subtypes of chronic inflammatory bowel disease (IBD) with increasing global incidence. New studies suggest that adopting a top-down strategy, characterized by the early initiation of biological therapy, yields superior disease control and enhances clinical outcomes. The utilization of biological therapy increases the susceptibility to opportunistic infections, such as tuberculosis (TB). We are witnessing an unexpected rise in TB infection incidence worldwide, posing additional challenges in managing patients with IBD. This study aimed to determine the prevalence of TB infection, including active TB infection (ATBI) and latent TB infection (LTBI), among IBD patients prior to initiating biological therapy. Additionally, the study aimed to investigate whether the presence of TB infection influenced the selection of biological drug. Methods In this retrospective study, we examined a cohort of 558 patients diagnosed with IBD, comprising 303 males and 255 females, with a mean age of 42±16 years. These patients were initiated on biological therapy between 2017 and 2024 at the Clinic for Gastroenterohepatology, University Clinical Center of Serbia. Screening for TB infection was conducted using interferon gamma release assey (IGRA) tests and chest X-rays for all participants. Results Out of the total 558 patients in the study, 306 of them were diagnosed with CD, while 252 had UC. A mere 19 patients (3,41%) tested positive for IGRA, with 2 patients (0,36%) having indeterminate results. Among the IGRA-positive patients, 18 of them were identified as having LTBI, while only 1 presented with ATBI. In the IGRA-positive group, 12 patients were diagnosed with UC, while 7 had CD. Among those with LTBI, the majority, comprising 15 patients, were started on vedolizumab therapy, with 13 of them receiving antituberculosis prophylaxis before initiation of the biological drug. One patient had ATBI and underwent full antituberculosis treatment before starting infliximab therapy. In cases where patients had indeterminate IGRA test results, additional diagnostic assessments were carried out, and TB infection was ruled out before commencing infliximab therapy. Notably, none of the patients in whom biological therapy was commenced developed ATBI during the follow-up period. Conclusion Screening for TB infection is imperative before initiating biological therapy in IBD patients, as the reactivation of LTBI caused by immunosuppression can lead to fatal complications. In our study, the majority of patients with LTBI were treated with vedolizumab, which has demonstrated exceptional safety profile for patients with LTBI, even in the absence of previous antituberculosis prophylaxis. References 1.Jin BC, Moon HJ, Kim SW. Latent and Active Tuberculosis Infection in Patients with Inflammatory Bowel Disease. The Korean Journal of Gastroenterology. 2022;80(2):72-76. doi:https://doi.org/10.4166/kjg.2022.086 2.Beaugerie L, Rahier JF, Kirchgesner J. Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020;18(6):1324-1335.e2. doi:10.1016/j.cgh.2020.02.009 3.Choi MG, Ye BD, Yang SK, Shim TS, Jo KW, Park SH. The Risk of Tuberculosis in Patients With Inflammatory Bowel Disease Treated With Vedolizumab or Ustekinumab in Korea. J Korean Med Sci. 2022;37(14):e107. Published 2022 Apr 11. doi:10.3346/jkms.2022.37.e107 4.Godfrey MS, Friedman LN. Tuberculosis and Biologic Therapies: Anti-Tumor Necrosis Factor-α and Beyond. Clin Chest Med. 2019;40(4):721-739. doi:10.1016/j.ccm.2019.07.003