Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management

Sasha R. Fehily; Aysha H. Al-Ani; Jonathan Abdelmalak; Clarissa Rentch; Eva Zhang; Justin T. Denholm; Douglas Johnson; Siew C. Ng; Vishal Sharma; David T. Rubin; Peter R. Gibson; Britt Christensen

doi:10.1111/apt.16952

Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management

Sasha R. Fehily, Aysha H. Al-Ani, Jonathan Abdelmalak, Clarissa Rentch, Eva Zhang, Justin T. Denholm, Douglas Johnson, Siew C. Ng, Vishal Sharma, David T. Rubin, Peter R. Gibson, Britt Christensen

Research output: Contribution to journal › Review article › peer-review

32 Citations (Scopus)

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Abstract

Background: One quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of active tuberculosis. Such reactivation carries a risk of significant morbidity and mortality. Despite the increasing global incidence of inflammatory bowel disease (IBD) and the use of immune-based therapies, current guidelines on the testing and treatment of LTBI in patients with IBD are haphazard with a paucity of evidence.

Aim: To review the screening, diagnostic practices and medical management of LTBI in patients with IBD.

Methods: Published literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD.

Results: Screening for LTBI should be performed proactively and includes assessment of risk factors, an interferon-gamma releasing assay or tuberculin skin test and chest X-ray. LTBI treatment in patients with IBD is scenario-dependent, related to geographical endemicity, travel and other factors. Ideally, LTBI therapy should be used prior to immune suppression but can be applied concurrently where urgent IBD medical treatment is required. Management is best directed by a multidisciplinary team involving gastroenterologists, infectious diseases specialists and pharmacists. Ongoing surveillance is recommended during therapy. Newer LTBI therapies show promise, but medication interactions need to be considered. There are major gaps in evidence, particularly with specific newer therapeutic approaches to IBD.

Conclusions: Proactive screening for LTBI is essential in patients with IBD undergoing immune-suppressing therapy and several therapeutic strategies are available. Reporting of real-world experience is essential to refining current management recommendations.

Original language	English
Pages (from-to)	6-27
Number of pages	22
Journal	Alimentary Pharmacology and Therapeutics
Volume	56
Issue number	1
DOIs	https://doi.org/10.1111/apt.16952
Publication status	Published - Jul 2022
Externally published	Yes

Bibliographical note

Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Humans
Immunosuppression Therapy/adverse effects
Inflammatory Bowel Diseases/complications
Interferon-gamma Release Tests
Latent Tuberculosis/diagnosis
Mass Screening
Tuberculin Test
Tumor Necrosis Factor-alpha

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10.1111/apt.16952Licence: CC BY-NC

Publisher version (open access)Final published version, 3.15 MBLicence: CC BY-NC

Cite this

Fehily, S. R., Al-Ani, A. H., Abdelmalak, J., Rentch, C., Zhang, E., Denholm, J. T., Johnson, D., Ng, S. C., Sharma, V., Rubin, D. T., Gibson, P. R., & Christensen, B. (2022). Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management. Alimentary Pharmacology and Therapeutics, 56(1), 6-27. https://doi.org/10.1111/apt.16952

@article{9a7c1a456d0640298d3105935d7e07b6,

title = "Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management",

abstract = "Background: One quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of active tuberculosis. Such reactivation carries a risk of significant morbidity and mortality. Despite the increasing global incidence of inflammatory bowel disease (IBD) and the use of immune-based therapies, current guidelines on the testing and treatment of LTBI in patients with IBD are haphazard with a paucity of evidence.Aim: To review the screening, diagnostic practices and medical management of LTBI in patients with IBD.Methods: Published literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD.Results: Screening for LTBI should be performed proactively and includes assessment of risk factors, an interferon-gamma releasing assay or tuberculin skin test and chest X-ray. LTBI treatment in patients with IBD is scenario-dependent, related to geographical endemicity, travel and other factors. Ideally, LTBI therapy should be used prior to immune suppression but can be applied concurrently where urgent IBD medical treatment is required. Management is best directed by a multidisciplinary team involving gastroenterologists, infectious diseases specialists and pharmacists. Ongoing surveillance is recommended during therapy. Newer LTBI therapies show promise, but medication interactions need to be considered. There are major gaps in evidence, particularly with specific newer therapeutic approaches to IBD.Conclusions: Proactive screening for LTBI is essential in patients with IBD undergoing immune-suppressing therapy and several therapeutic strategies are available. Reporting of real-world experience is essential to refining current management recommendations.",

keywords = "Humans, Immunosuppression Therapy/adverse effects, Inflammatory Bowel Diseases/complications, Interferon-gamma Release Tests, Latent Tuberculosis/diagnosis, Mass Screening, Tuberculin Test, Tumor Necrosis Factor-alpha",

author = "Fehily, {Sasha R.} and Al-Ani, {Aysha H.} and Jonathan Abdelmalak and Clarissa Rentch and Eva Zhang and Denholm, {Justin T.} and Douglas Johnson and Ng, {Siew C.} and Vishal Sharma and Rubin, {David T.} and Gibson, {Peter R.} and Britt Christensen",

note = "Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2022",

month = jul,

doi = "10.1111/apt.16952",

language = "English",

volume = "56",

pages = "6--27",

journal = "Alimentary Pharmacology and Therapeutics",

issn = "0269-2813",

publisher = "Wiley-Blackwell, Wiley",

number = "1",

}

Fehily, SR, Al-Ani, AH, Abdelmalak, J, Rentch, C, Zhang, E, Denholm, JT, Johnson, D, Ng, SC, Sharma, V, Rubin, DT, Gibson, PR & Christensen, B 2022, 'Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management', Alimentary Pharmacology and Therapeutics, vol. 56, no. 1, pp. 6-27. https://doi.org/10.1111/apt.16952

Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management. / Fehily, Sasha R.; Al-Ani, Aysha H.; Abdelmalak, Jonathan et al.
In: Alimentary Pharmacology and Therapeutics, Vol. 56, No. 1, 07.2022, p. 6-27.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Review article

T2 - latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management

AU - Fehily, Sasha R.

AU - Al-Ani, Aysha H.

AU - Abdelmalak, Jonathan

AU - Rentch, Clarissa

AU - Zhang, Eva

AU - Denholm, Justin T.

AU - Johnson, Douglas

AU - Ng, Siew C.

AU - Sharma, Vishal

AU - Rubin, David T.

AU - Gibson, Peter R.

AU - Christensen, Britt

N1 - Copyright the Author(s) 2022. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2022/7

Y1 - 2022/7

N2 - Background: One quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of active tuberculosis. Such reactivation carries a risk of significant morbidity and mortality. Despite the increasing global incidence of inflammatory bowel disease (IBD) and the use of immune-based therapies, current guidelines on the testing and treatment of LTBI in patients with IBD are haphazard with a paucity of evidence.Aim: To review the screening, diagnostic practices and medical management of LTBI in patients with IBD.Methods: Published literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD.Results: Screening for LTBI should be performed proactively and includes assessment of risk factors, an interferon-gamma releasing assay or tuberculin skin test and chest X-ray. LTBI treatment in patients with IBD is scenario-dependent, related to geographical endemicity, travel and other factors. Ideally, LTBI therapy should be used prior to immune suppression but can be applied concurrently where urgent IBD medical treatment is required. Management is best directed by a multidisciplinary team involving gastroenterologists, infectious diseases specialists and pharmacists. Ongoing surveillance is recommended during therapy. Newer LTBI therapies show promise, but medication interactions need to be considered. There are major gaps in evidence, particularly with specific newer therapeutic approaches to IBD.Conclusions: Proactive screening for LTBI is essential in patients with IBD undergoing immune-suppressing therapy and several therapeutic strategies are available. Reporting of real-world experience is essential to refining current management recommendations.

AB - Background: One quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of active tuberculosis. Such reactivation carries a risk of significant morbidity and mortality. Despite the increasing global incidence of inflammatory bowel disease (IBD) and the use of immune-based therapies, current guidelines on the testing and treatment of LTBI in patients with IBD are haphazard with a paucity of evidence.Aim: To review the screening, diagnostic practices and medical management of LTBI in patients with IBD.Methods: Published literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD.Results: Screening for LTBI should be performed proactively and includes assessment of risk factors, an interferon-gamma releasing assay or tuberculin skin test and chest X-ray. LTBI treatment in patients with IBD is scenario-dependent, related to geographical endemicity, travel and other factors. Ideally, LTBI therapy should be used prior to immune suppression but can be applied concurrently where urgent IBD medical treatment is required. Management is best directed by a multidisciplinary team involving gastroenterologists, infectious diseases specialists and pharmacists. Ongoing surveillance is recommended during therapy. Newer LTBI therapies show promise, but medication interactions need to be considered. There are major gaps in evidence, particularly with specific newer therapeutic approaches to IBD.Conclusions: Proactive screening for LTBI is essential in patients with IBD undergoing immune-suppressing therapy and several therapeutic strategies are available. Reporting of real-world experience is essential to refining current management recommendations.

KW - Humans

KW - Immunosuppression Therapy/adverse effects

KW - Inflammatory Bowel Diseases/complications

KW - Interferon-gamma Release Tests

KW - Latent Tuberculosis/diagnosis

KW - Mass Screening

KW - Tuberculin Test

KW - Tumor Necrosis Factor-alpha

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U2 - 10.1111/apt.16952

DO - 10.1111/apt.16952

M3 - Review article

C2 - 35596242

SN - 0269-2813

VL - 56

SP - 6

EP - 27

JO - Alimentary Pharmacology and Therapeutics

JF - Alimentary Pharmacology and Therapeutics

IS - 1

ER -

Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management

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