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

摘要

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 antituberculoustreatment 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 immunosuppressivetherapy 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 isoniazidfor six months. For how to minimise the risk of TB in the small minority of patients with inflammatory bowel disease not on immunosuppressivetreatment, readers are referred to the more detailed guidelines published in Thorax.