Prevalence and clinical impact of latent tuberculosis infection in patients with inflammatory bowel disease in Japan: a retrospective multicenter study by the IBD-Quality team

Background Screening and preventive treatment are recommended for latent tuberculosis infection (LTBI) before immunosuppressive therapy in patients with inflammatory bowel disease (IBD). However, the prevalence of LTBI and active tuberculosis, combined with their influence on selection of immunosuppressive therapy, remains uncertain. This retrospective multicenter study aimed to determine the prevalence of LTBI and to evaluate therapeutic management in Japanese patients with IBD according to tuberculosis infection status. Methods The clinical profiles and therapeutic management of patients with IBD who were screened for LTBI at any of 10 Japanese institutions between July 2010 and June 2020 were identified by review of the electronic medical records. LTBI was defined as positive when an interferon-gamma release assay or tuberculin test was positive with a normal chest radiograph. Results A total of 4257 patients with IBD (Crohn's disease, n = 1646; ulcerative colitis, n = 2611) were included. Sixty-nine patients (1.62%) tested positive for LTBI. Ustekinumab and vedolizumab were used significantly more often in the LTBI group than in the non-LTBI group. Fifty-seven patients (82.6%) in the LTBI group received preventive treatment, while 12 (17.4%) were followed without treatment; only ustekinumab and vedolizumab were selected as advanced therapies. During follow-up, two patients developed active tuberculosis after preventive therapy while receiving immunosuppressive agents. Conclusions The prevalence of LTBI among Japanese patients with IBD was 1.62%. Both LTBI status and use of preventive treatment may influence selection of advanced therapies for IBD. Although rare, active tuberculosis can occur despite preventive treatment, highlighting the need for appropriate monitoring strategies.