@article{249d01077cf446868fa91e87ac00bc0e,
title = "Review article: Latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression—Risks, screening, diagnosis and management",
abstract = "Background: One quarter of the world's population has latent tuberculosis infection (LTBI). Systemic immunosuppression is a risk factor for LTBI reactivation and the development of active tuberculosis. Such reactivation carries a risk of significant morbidity and mortality. Despite the increasing global incidence of inflammatory bowel disease (IBD) and the use of immune-based therapies, current guidelines on the testing and treatment of LTBI in patients with IBD are haphazard with a paucity of evidence. Aim: To review the screening, diagnostic practices and medical management of LTBI in patients with IBD. Methods: Published literature was reviewed, and recommendations for testing and treatment were synthesised by experts in both infectious diseases and IBD. Results: Screening for LTBI should be performed proactively and includes assessment of risk factors, an interferon-gamma releasing assay or tuberculin skin test and chest X-ray. LTBI treatment in patients with IBD is scenario-dependent, related to geographical endemicity, travel and other factors. Ideally, LTBI therapy should be used prior to immune suppression but can be applied concurrently where urgent IBD medical treatment is required. Management is best directed by a multidisciplinary team involving gastroenterologists, infectious diseases specialists and pharmacists. Ongoing surveillance is recommended during therapy. Newer LTBI therapies show promise, but medication interactions need to be considered. There are major gaps in evidence, particularly with specific newer therapeutic approaches to IBD. Conclusions: Proactive screening for LTBI is essential in patients with IBD undergoing immune-suppressing therapy and several therapeutic strategies are available. Reporting of real-world experience is essential to refining current management recommendations.",
author = "Fehily, {Sasha R.} and Al-Ani, {Aysha H.} and Jonathan Abdelmalak and Clarissa Rentch and Eva Zhang and Denholm, {Justin T.} and Douglas Johnson and Ng, {Siew C.} and Vishal Sharma and Rubin, {David T.} and Gibson, {Peter R.} and Britt Christensen",
note = "Funding Information: SF has received an education grant from Pfizer. AA is funded by scholarships from Crohn{\textquoteright}s and Colitis Australia, Avant, the Australian Commonwealth Government and University of Melbourne and received grants from the Gastroenterological Society of Australia/Celltrion Healthcare and Janssen. Personal and funding interests: Funding Information: Ralley Prentice contributed to some grammatical edits to the study. Eva Zhang is supported by a Pfizer Grant to support her fellowship. Aysha H. Al‐Ani is supported by an Australian Commonwealth Government Research grant, a Crohn{\textquoteright}s Colitis Foundation scholarship and a University of Melbourne Scholarship. Sasha Fehily is supported by an NHMRC scholarship to support her fellowship, and has recieved Pfizer funding contribution towards a conference attendance. All authors approved the final version of the manuscript. Funding Information: CR: Has served as a speaker for Pfizer. DJ: Douglas Johnson has served as a speaker for Pfizer. He is an employee of the Royal Melbourne Hospital and has no other conflicts of interest or declarations. SN has received research grants from Ferring and Abbvie and speakers honorarium from Janssen, Abbvie, Tillotts, Takeda, Olympus and Ferring. DR reports grants and personal fees from Abbvie, personal feesfrom Abgenomics, personal fees from Allergan Inc, personal feesfrom Boehringer Ingelheim Ltd, personal fees from Bristol‐MyersSquibb, personal fees from Celgene Corp/Syneos, personal feesfrom Check‐cap, personal fees from Dizal Pharmaceuticals, personalfees from GalenPharma/Atlantica, grants and personal fees fromGenentech/Roche, personal fees from Gilead Sciences, personalfees from Ichnos Sciences, personal fees from GlaxoSmithKlineGroup, grants and personal fees from Janssen Pharmaceuticals, personal fees from Lilly, personal fees from Narrow River Mgmt, personal fees from Pfizer, grants and personal fees from PrometheusLaboratories, personal fees from Reistone, grants and personal feesfrom Shire, grants and personal fees from Takeda, personal feesfrom Techlab, Inc, outside the submitted work. Professor Gibson has served as a consultant or advisory board member for Anatara, Atmo Biosciences, Immunic Therapeutics, Novozymes, Novoviah and Comvita. He has received research grants for investigator‐driven studies from Atmo Biosciences. He holds shares in Atmo Biosciences. His Department financially benefits from the sales of a digital application, booklets and online courses on the FODMAP diet. BC has received speaking fees from Abbvie, Jannsen, Pfizer, Takeda, Falk Pharmaceuticals, Chiesi and Ferring, research grants from Janssen and Ferring Pharmaceuticals and served on the advisory board of Gilead, Janssen, Celltrion, Abbvie and Novartis Declaration of personal interests: Publisher Copyright: {\textcopyright} 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.",
year = "2022",
month = jul,
doi = "10.1111/apt.16952",
language = "English",
volume = "56",
pages = "6--27",
journal = "Alimentary Pharmacology & Therapeutics",
issn = "0269-2813",
publisher = "Wiley-Blackwell",
number = "1",
}
