Investigation on status quo of tuberculosis screening in 1711 patients with inflammatory bowel diseases before infliximab therapy in China

Objective To investigate the status quo of tuberculosis (TB) screening among patients with inflammatory bowel diseases (IBD) before receiving infliximab (IFX) therapy in China. Methods IBD patients receiving IFX treatment during January 2009 to December 2016 from 22 hospitals nationwide were enrolled retrospectively. Clinical data of TB screening before IFX therapy, including previous TB history, tuberculin test (TST test) , interferon-γ release assay (IGRA) and chest image results (chest X-ray and chest CT) were all recorded. TB screening result whether was latent tuberculosis infection (LTBI) judged by the doctor and clinical data related to whether receiving prophylactic treatment were collected. Results A total of 1711 IBD patients were enrolled, including 1606 (93.9%) cases receiving TB screening with TST or IGRA combining chest X-ray or CT scan before IFX treatment, 663 (38.7%) cases with IGRA combining chest CT scan, and only 504 (29.5%) cases with complete TST plus IGRA combining chest CT scan, while 77 (4.5%) cases had no chest imaging screening and 66 (3.9%) cases did not receive any screening for TST or IGRA. TB screening results before IFX treatment showed 7.1% (121/1711) of IBD patients were LTBI, in whom 27 (27/121, 22.3%) IBD patients with LTBI were neglected by clinicians, presenting as omission of judgment for LTBI or failure to take prophylactic anti-TB treatment during IFX treatment. Conclusions The TB screening before IFX treatment in China is not sufficient at present. The LTBI prevalence of IBD patients in China may be on the low side and clinicians have no enough knowledge of LTBI. It is recommended that IBD patients should undergo a standard TB screening before IFX therapy. Key words: Inflammatory bowel diseases; Infliximab; Latent tuberculosis infection; Tuberculosis infection