COMMENTARY

TB in patients with Crohn's disease

Preventing TB in patients with Crohn’s disease needing infliximab or other anti-TNF therapy

D S Rampton

Correspondence to:
Professor D S Rampton
Endoscopy Unit, Royal London Hospital, London E1 1BB, UK; d.rampton@qmul.ac.uk

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In patients with Crohn’s disease, the increased risk of active tuberculosis (TB) associated with infliximab makes it necessary to screen for active and latent TB before this or other anti-tumour necrosis factor treatment is begun. This paper outlines how such screening should be undertaken, and how to decide which patients need antituberculous treatment or chemoprophylaxis before infliximab.

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Keywords: Crohn’s disease; ulcerative colitis; infliximab; tumour necrosis factor; tuberculosis

The first 150 words of the full text of this article appear below.

The increased risk of active tuberculosis (TB) associated with infliximab makes necessary a screen for active and latent TB before this or other anti-tumour necrosis factor (TNF) treatment is begun in patients with Crohn’s disease. This paper outlines how such screening should be undertaken, and how to decide which patients need antituberculous treatment or chemoprophylaxis before infliximab. All patients need a careful history for TB and a chest x ray. The minority of patients with a history of TB or an abnormal chest x ray should be referred for assessment by a TB specialist. Of the remainder, those with Crohn’s disease who are on immunosuppressive therapy do not require tuberculin testing. Comparison of their risk of TB while on anti-TNF therapy with the risks of chemoprophylaxis induced hepatitis indicates that black Africans aged over 15 years, South Asians born outside the UK, and other . . . [Full text of this article]

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This article has been cited by other articles:

• Cummings, J R F., Keshav, S., Travis, S. P L (2008). Medical management of Crohn's disease. BMJ 336: 1062-1066 [Full Text]  
• Ormerod, L P, Rampton, D S (2008). Authors' response. Gut 57: 425-426 [Full Text]  
• Travis, S P L, Stange, E F, Lemann, M, Oresland, T, Chowers, Y, Forbes, A, D'Haens, G, Kitis, G, Cortot, A, Prantera, C, Marteau, P, Colombel, J-F, Gionchetti, P, Bouhnik, Y, Tiret, E, Kroesen, J, Starlinger, M, Mortensen, N J, for the European Crohn's and Colitis Organisation, (2006). European evidence based consensus on the diagnosis and management of Crohn's disease: current management. Gut 55: i16-i35 [Abstract] [Full Text]  

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Tuberculosis & Infliximab

Christian P Selinger, et al.

Gut Online, 14 Nov 2005 [Full text]