Article Text
PDF
Statistics from Altmetric.com
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.
SUMMARY
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 ethnic groups resident in the UK for less than five years should be considered for chemoprophylaxis with isoniazid for six months. For how to minimise the risk of TB in the small minority of patients with inflammatory bowel disease not on immunosuppressive treatment, readers are referred to the more detailed guidelines published in Thorax.1
INTRODUCTION
Infliximab is of proven benefit in the treatment of chronic active Crohn’s disease2 as well as in rheumatoid arthritis3 and ankylosing spondylitis4; preliminary data suggest it may also have a therapeutic role in refractory active ulcerative colitis.5–7 …