Kim Kyuwon, Jo Kyung-Wook, Shim Tae Sun, Park Jin Hwa, Hwang Sung Wook, Park Sang Hyoung, Yang Dong-Hoon, Byeon Jeong-Sik, Myung Seung-Jae, Yang Suk-Kyun, Ye Byong Duk
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Pulmonology and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Front Med (Lausanne). 2021 May 21;8:670242. doi: 10.3389/fmed.2021.670242. eCollection 2021.
Considering the risk of reactivation of latent tuberculosis infection (LTBI), not only before starting tumor necrosis factor inhibitors but also before non-TNF inhibitor therapy, LTBI screening is routinely recommended for patients with inflammatory bowel disease (IBD). However, data on the positive conversion of LTBI test results during non-TNF inhibitor therapy are scarce. Among IBD patients treated with vedolizumab and/or ustekinumab, a total of 91 patients who had negative baseline interferon-gamma release assay (IGRA) results, assessed by QuantiFERON-TB Gold In-tube or QuantiFERON-TB Gold Plus, were enrolled. Serial LTBI test results after starting non-TNF inhibitor therapy were collected, and patients' clinical characteristics were analyzed. Positive IGRA conversion was observed in six of 91 patients (6.6%). The cumulative IGRA conversion-free survival rates after starting therapy were 97.7% after 1 year and 86.7% after 2 years. Ulcerative colitis was more common among converters compared with non-converters (66.7 vs. 23.5%, = 0.040). Among six converters, four had been treated with vedolizumab, one with ustekinumab, and the other with vedolizumab followed by ustekinumab. All six patients had been previously exposed to TNF inhibitors before non-TNF inhibitor therapy: five to infliximab and one to both infliximab and adalimumab. After positive IGRA conversion, none of the six converters developed active tuberculosis while maintaining non-TNF inhibitor therapy (median 6.8 months, range 0.4-32.1 months). Positive IGRA conversion among IBD patients treated with vedolizumab and/or ustekinumab appears to occur somewhat frequently, but its clinical implications remain to be elucidated.
考虑到潜伏性结核感染（LTBI）再激活的风险，不仅在开始使用肿瘤坏死因子抑制剂之前，而且在开始非肿瘤坏死因子抑制剂治疗之前，常规建议对炎症性肠病（IBD）患者进行LTBI筛查。然而，关于非肿瘤坏死因子抑制剂治疗期间LTBI检测结果阳转的数据很少。在接受维多珠单抗和/或优特克单抗治疗的IBD患者中，共有91例基线干扰素-γ释放试验（IGRA）结果为阴性的患者入组，这些结果通过管内QuantiFERON-TB Gold或QuantiFERON-TB Gold Plus进行评估。收集开始非肿瘤坏死因子抑制剂治疗后的系列LTBI检测结果，并分析患者的临床特征。91例患者中有6例（6.6%）出现IGRA阳转。开始治疗后1年和2年的累积无IGRA阳转生存率分别为97.7%和86.7%。与未阳转者相比，溃疡性结肠炎在阳转者中更为常见（66.7%对23.5%，P = 0.040）。在6例阳转者中，4例接受过维多珠单抗治疗，1例接受过优特克单抗治疗，另1例先接受维多珠单抗治疗后接受优特克单抗治疗。所有6例患者在接受非肿瘤坏死因子抑制剂治疗之前均曾接触过肿瘤坏死因子抑制剂：5例接触过英夫利昔单抗，1例接触过英夫利昔单抗和阿达木单抗。IGRA阳转后，6例阳转者在维持非肿瘤坏死因子抑制剂治疗期间均未发生活动性结核（中位时间6.8个月，范围0.4 - 32.1个月）。接受维多珠单抗和/或优特克单抗治疗的IBD患者中IGRA阳转似乎较为常见，但其临床意义仍有待阐明。
