Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Citations

Citations to this article as recorded by  

• Risk of Tuberculosis and Hepatitis B Reactivation in Patients With Crohn’s Disease on Ustekinumab: A Nationwide Real-World Study
  Rongbei Liu, Zhilun Li, Lingna Ye, Jing Hu, Jian Tang, Baili Chen, Xiuli Chen, Bei Tan, Yubei Gu, Chen Xie, Chunhui Ouyang, Xiaomei Song, Fan Li, Yanyun Fan, Haixia Ren, Liangru Zhu, Min Chen, Wenyu Jiang, Qian Cao
  Inflammatory Bowel Diseases.2024; 30(1): 45.     CrossRef
• Reduced gut microbiota diversity in ulcerative colitis patients with latent tuberculosis infection during vedolizumab therapy: insights on prophylactic anti-tuberculosis effects
  Yibing Hu, Zhenping Wu, Xiaoyun Yang, Jin Ding, Qunying Wang, Hao Fang, Lujian Zhu, Minli Hu
  BMC Microbiology.2024;[Epub]     CrossRef
• Medical management of pediatric inflammatory bowel disease in the Asia‐Pacific region: A position paper by the Asian Pan‐Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD Working Group
  Way Seah Lee, Katsuhiro Arai, George Alex, Suporn Treepongkaruna, Kyung Mo Kim, Chee Liang Choong, Karen S. C. Mercado, Andy Darma, Anshu Srivastava, Marion M. Aw
  Journal of Gastroenterology and Hepatology.2023; 38(4): 523.     CrossRef
• Korean clinical practice guidelines on biologics and small molecules for moderate-to-severe ulcerative colitis
  Soo-Young Na, Chang Hwan Choi, Eun Mi Song, Ki Bae Bang, Sang Hyoung Park, Eun Soo Kim, Jae Jun Park, Bora Keum, Chang Kyun Lee, Bo-In Lee, Seung-Bum Ryoo, Seong-Joon Koh, Miyoung Choi, Joo Sung Kim
  Intestinal Research.2023; 21(1): 61.     CrossRef
• Miliary Tuberculosis in a Patient With Ulcerative Colitis Treated With Tofacitinib
  Shruti Verma, Arshdeep Singh, Chandan Kakkar, Ashish Tripathi, Vandana Midha, Ajit Sood
  ACG Case Reports Journal.2023; 10(6): e01066.     CrossRef
• IBD barriers across the continents – East Asia
  Joyce Wing Yan Mak, Agnes Hiu Yan Ho, Siew Chien Ng
  Therapeutic Advances in Gastroenterology.2023;[Epub]     CrossRef
• Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review
  Jae Hoon Jung, Sujin Choi, Youra Kang, Dae-Chul Cho, So Mi Lee, Tae In Park, Byung-Ho Choe, Dongsub Kim, Ben Kang
  Frontiers in Pediatrics.2022;[Epub]     CrossRef
• A case of paradoxical response during anti-tuberculosis treatment in a patient with ulcerative colitis
  Shuhei Hosomi, Naoko Sugita, Atsushi Kanamori, Masaki Ominami, Koji Otani, Noriko Kamata, Fumio Tanaka, Yasuaki Nagami, Koichi Taira, Yasuhiro Fujiwara
  Clinical Journal of Gastroenterology.2022; 15(3): 592.     CrossRef
• Prophylactic Antitubercular Therapy Is Associated With Accelerated Disease Progression in Patients With Crohn's Disease Receiving Anti-TNF Therapy: A Retrospective Multicenter Study
  Fen Liu, Jian Tang, Lingna Ye, Jinyu Tan, Yun Qiu, Fan Hu, Jinshen He, Baili Chen, Yao He, Zhirong Zeng, Ren Mao, Qian Cao, Xiang Gao, Minhu Chen
  Clinical and Translational Gastroenterology.2022; 13(6): e00493.     CrossRef
• Successful treatment with vedolizumab in an adolescent with Crohn disease who had developed active pulmonary tuberculosis while receiving infliximab
  Sujin Choi, Bong Seok Choi, Byung-Ho Choe, Ben Kang
  Yeungnam University Journal of Medicine.2021; 38(3): 251.     CrossRef
• Current status of inflammatory bowel diseases in Korea
  Suk-Kyun Yang
  Journal of the Korean Medical Association.2021; 64(9): 572.     CrossRef
• Anti-tumor Necrosis Factor Agents and Tuberculosis in Inflammatory Bowel Disease
  Yunho Jung
  The Korean Journal of Gastroenterology.2020; 75(1): 1.     CrossRef
• Clinical Features and Outcomes of Tuberculosis in Inflammatory Bowel Disease Patients Treated with Anti-tumor Necrosis Factor Therapy
  Jihye Kim, Jong Pil Im, Jae-Joon Yim, Chang Kyun Lee, Dong Il Park, Chang Soo Eun, Sung-Ae Jung, Jeong Eun Shin, Kang-Moon Lee, Jae Hee Cheon
  The Korean Journal of Gastroenterology.2020; 75(1): 29.     CrossRef
• Preoperative hypoalbuminemia is an independent risk factor for postoperative complications in Crohn's disease patients with normal BMI: A cohort study
  Xiaolong Ge, Huaying Liu, Shasha Tang, Yan Wu, Yipeng Pan, Wei Liu, Weilin Qi, Lingna Ye, Qian Cao, Wei Zhou
  International Journal of Surgery.2020; 79: 294.     CrossRef
• Biologics for the Management of Inflammatory Bowel Disease: A Review in Tuberculosis-Endemic Countries
  Rupa Banerjee, Raja Affendi Raja Ali, Shu Chen Wei, Shashi Adsul
  Gut and Liver.2020; 14(6): 685.     CrossRef
• Comparison of outcomes of continuation/discontinuation of 5-aminosalicylic acid after initiation of anti-tumor necrosis factor-alpha therapy in patients with inflammatory bowel disease
  Youn I Choi, Tae Jun Kim, Dong Kyun Park, Jun-won Chung, Kyoung Oh Kim, Kwang An Kwon, Yoon Jae Kim
  International Journal of Colorectal Disease.2019; 34(10): 1713.     CrossRef
• Translating the gut microbiome: ready for the clinic?
  Susan V. Lynch, Siew C. Ng, Fergus Shanahan, Herbert Tilg
  Nature Reviews Gastroenterology & Hepatology.2019; 16(11): 656.     CrossRef
• Multidrug-resistant Disseminated Tuberculosis Related to Infliximab in a Patient with Ulcerative Colitis and Negative Evaluation for Latent Tuberculosis
  Yu Kyung Jun, Jaeyoung Chun, Eun Ae Kang, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim
  The Korean Journal of Gastroenterology.2019; 74(3): 168.     CrossRef
• Evidence-based consensus on opportunistic infections in inflammatory bowel disease (republication)
  
  Intestinal Research.2018; 16(2): 178.     CrossRef
• A rare case of disseminated histoplasmosis in a patient with Crohn’s disease on immunosuppressive treatment
  Bhavesh Bhut, Akshay Kulkarni, Varnika Rai, Vinita Agrawal, Abhai Verma, Manoj Jain, Rungmei S K Marak, Ajai Kumar Dixit, Uday C Ghoshal
  Indian Journal of Gastroenterology.2018; 37(5): 472.     CrossRef
• High risk of tuberculosis during infliximab therapy despite tuberculosis screening in inflammatory bowel disease patients in India
  Ashish Agarwal, Saurabh Kedia, Saransh Jain, Vipin Gupta, Sawan Bopanna, Dawesh P Yadav, Sandeep Goyal, Venigalla Pratap Mouli, Rajan Dhingra, Govind Makharia, Vineet Ahuja
  Intestinal Research.2018; 16(4): 588.     CrossRef

Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web-based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommendaduring anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.

Citations

Citations to this article as recorded by  

• Risk of Tuberculosis and Hepatitis B Reactivation in Patients With Crohn’s Disease on Ustekinumab: A Nationwide Real-World Study
  Rongbei Liu, Zhilun Li, Lingna Ye, Jing Hu, Jian Tang, Baili Chen, Xiuli Chen, Bei Tan, Yubei Gu, Chen Xie, Chunhui Ouyang, Xiaomei Song, Fan Li, Yanyun Fan, Haixia Ren, Liangru Zhu, Min Chen, Wenyu Jiang, Qian Cao
  Inflammatory Bowel Diseases.2024; 30(1): 45.     CrossRef
• (Re-)introduction of TNF antagonists and JAK inhibitors in patients with previous tuberculosis: a systematic review
  Thomas Theo Brehm, Maja Reimann, Niklas Köhler, Christoph Lange
  Clinical Microbiology and Infection.2024; 30(8): 989.     CrossRef
• Ten missteps in the management of inflammatory bowel disease in Asia: An expert report by the Asian Pacific Association of Gastroenterology Working Group on Inflammatory Bowel Disease
  Vineet Ahuja, Ida Hilmi, Byong Duk Ye, Khoon Lin Ling, Siew C. Ng, Rupert W. Leong, Peeyush Kumar, Xin Hui Khoo, Govind K. Makharia, Jose Sollano, Pises Pisespongsa, Nazri Mustaffa, Rupa Banerjee, Alex Hwong‐Ruey Leow, Raja Affendi Raja Ali, Sai Wei Chuah
  Journal of Gastroenterology and Hepatology.2024; 39(8): 1500.     CrossRef
• Korean clinical practice guidelines on biologics and small molecules for moderate-to-severe ulcerative colitis
  Soo-Young Na, Chang Hwan Choi, Eun Mi Song, Ki Bae Bang, Sang Hyoung Park, Eun Soo Kim, Jae Jun Park, Bora Keum, Chang Kyun Lee, Bo-In Lee, Seung-Bum Ryoo, Seong-Joon Koh, Miyoung Choi, Joo Sung Kim
  Intestinal Research.2023; 21(1): 61.     CrossRef
• Thiopurines are an independent risk factor for active tuberculosis in inflammatory bowel disease patients
  Flora Maria Lorenzo Fortes, Raquel Rocha, Genoile Oliveira Santana
  World Journal of Gastroenterology.2023; 29(9): 1536.     CrossRef
• Bronchoesophageal fistula in a patient with Crohn’s disease receiving anti-tumor necrosis factor therapy
  Kyunghwan Oh, Kee Don Choi, Hyeong Ryul Kim, Tae Sun Shim, Byong Duk Ye, Suk-Kyun Yang, Sang Hyoung Park
  Clinical Endoscopy.2023; 56(2): 239.     CrossRef
• Miliary Tuberculosis in a Patient With Ulcerative Colitis Treated With Tofacitinib
  Shruti Verma, Arshdeep Singh, Chandan Kakkar, Ashish Tripathi, Vandana Midha, Ajit Sood
  ACG Case Reports Journal.2023; 10(6): e01066.     CrossRef
• Intestinal tuberculosis can masquerade as Crohn’s disease: A teachable moment
  Pooja KC, Madhur Bhattarai, Subodh Adhikari, Prakriti Parajuli, Sujata Bhandari, Himal Bikram Bhattarai, Niraj Kumar Sharma, Shailendra Karki, Suryakiran Acharya, Bibhusan Basnet
  SAGE Open Medical Case Reports.2023;[Epub]     CrossRef
• The safety of vedolizumab in a patient with Crohn’s disease who developed anti-TNF-alpha agent associated latent tuberculosis infection reactivation: A case report
  Yuya Sugiyama, Nobuhiro Ueno, Shion Tachibana, Yu Kobayashi, Yuki Murakami, Takahiro Sasaki, Aki Sakatani, Keitaro Takahashi, Katsuyoshi Ando, Shin Kashima, Kentaro Moriichi, Hiroki Tanabe, Toshikatsu Okumura, Mikihiro Fujiya
  Medicine.2023; 102(28): e34331.     CrossRef
• Tofacitinib in Steroid-Refractory Acute Severe Ulcerative Colitis: A Retrospective Analysis
  Sayan Malakar, Srikanth Kothalkar, Umair Shamsul Hoda, Uday C Ghoshal
  Cureus.2023;[Epub]     CrossRef
• Crohn’s disease and intestinal tuberculosis: challenging from every angle
  Andreia Guimarães, João Gama, Luis Curvo-Semedo, António Canaveira Manso
  BMJ Case Reports.2023; 16(12): e254400.     CrossRef
• Development of Spinal Tuberculosis in an Adolescent With Crohn's Disease After Infliximab Therapy: A Case Report With Literature Review
  Jae Hoon Jung, Sujin Choi, Youra Kang, Dae-Chul Cho, So Mi Lee, Tae In Park, Byung-Ho Choe, Dongsub Kim, Ben Kang
  Frontiers in Pediatrics.2022;[Epub]     CrossRef
• Increased Risk of Infection With High Infliximab Trough Level
  Suprabhat Giri, Harish Darak
  Journal of Clinical Gastroenterology.2022; 56(4): 374.     CrossRef
• Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
  Chan Hyuk Park, Jung Ho Park, Yoon Suk Jung
  Journal of Personalized Medicine.2022; 12(3): 507.     CrossRef
• Evidence-Based Commentary: Testing and Treating Latent Tuberculosis Before Starting Biologics and Small Molecules in Patients with Inflammatory Bowel Disease
  Rinkalben Kakadiya, Vishal Sharma
  Journal of Gastrointestinal Infections.2022; 12(02): 128.     CrossRef
• Frequency of Positive Conversion of Interferon-Gamma Release Assay Results Among Patients With Inflammatory Bowel Disease Treated With Non-tumor Necrosis Factor Inhibitors
  Kyuwon Kim, Kyung-Wook Jo, Tae Sun Shim, Jin Hwa Park, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Byong Duk Ye
  Frontiers in Medicine.2021;[Epub]     CrossRef
• Successful treatment with vedolizumab in an adolescent with Crohn disease who had developed active pulmonary tuberculosis while receiving infliximab
  Sujin Choi, Bong Seok Choi, Byung-Ho Choe, Ben Kang
  Yeungnam University Journal of Medicine.2021; 38(3): 251.     CrossRef
• Safety and effectiveness of adalimumab in the treatment of ulcerative colitis: results from a large-scale, prospective, multicenter, observational study
  Haruhiko Ogata, Takashi Hagiwara, Takeshi Kawaberi, Mariko Kobayashi, Toshifumi Hibi
  Intestinal Research.2021; 19(4): 419.     CrossRef
• Targeted versus universal tuberculosis chemoprophylaxis in 1968 patients with inflammatory bowel disease receiving anti‐TNF therapy in a tuberculosis endemic region
  Lingna Ye, Thomas P. Chapman, Zhenzhen Wen, Lang Lin, Yun Qiu, Zhanju Liu, Zhihua Ran, Jiaming Qian, Kaichun Wu, Xiang Gao, Pinjin Hu, Minhu Chen, Simon P. L. Travis, Qian Cao
  Alimentary Pharmacology & Therapeutics.2021; 53(3): 390.     CrossRef
• Biologics for the Management of Inflammatory Bowel Disease: A Review in Tuberculosis-Endemic Countries
  Rupa Banerjee, Raja Affendi Raja Ali, Shu Chen Wei, Shashi Adsul
  Gut and Liver.2020; 14(6): 685.     CrossRef
• Increased Risk of Herpes Zoster in Young and Metabolically Healthy Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Study
  Hosim Soh, Jaeyoung Chun, Kyungdo Han, Seona Park, Gukhwan Choi, Jihye Kim, Jooyoung Lee, Jong Pil Im, Joo Sung Kim
  Gut and Liver.2019; 13(3): 333.     CrossRef
• Screening for latent tuberculosis in patients with inflammatory bowel disease under antitumor necrosis factor: data from a Portuguese center
  Mafalda Sousa, Inês Ladeira, Ana Ponte, Carlos Fernandes, Adélia Rodrigues, Ana P. Silva, João Silva, Catarina Gomes, Edgar Afeto, João Carvalho
  European Journal of Gastroenterology & Hepatology.2019; 31(9): 1099.     CrossRef
• The Use of Biologics and Biosimilar in Asian patients with IBD: Are we ready?
  Joyce WY Mak, Joseph JY Sung
  Journal of Gastroenterology and Hepatology.2019; 34(8): 1269.     CrossRef
• Comparison of outcomes of continuation/discontinuation of 5-aminosalicylic acid after initiation of anti-tumor necrosis factor-alpha therapy in patients with inflammatory bowel disease
  Youn I Choi, Tae Jun Kim, Dong Kyun Park, Jun-won Chung, Kyoung Oh Kim, Kwang An Kwon, Yoon Jae Kim
  International Journal of Colorectal Disease.2019; 34(10): 1713.     CrossRef
• Multidrug-resistant Disseminated Tuberculosis Related to Infliximab in a Patient with Ulcerative Colitis and Negative Evaluation for Latent Tuberculosis
  Yu Kyung Jun, Jaeyoung Chun, Eun Ae Kang, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim
  The Korean Journal of Gastroenterology.2019; 74(3): 168.     CrossRef
• Evidence-based consensus on opportunistic infections in inflammatory bowel disease (republication)
  
  Intestinal Research.2018; 16(2): 178.     CrossRef
• High risk of tuberculosis during infliximab therapy despite tuberculosis screening in inflammatory bowel disease patients in India
  Ashish Agarwal, Saurabh Kedia, Saransh Jain, Vipin Gupta, Sawan Bopanna, Dawesh P Yadav, Sandeep Goyal, Venigalla Pratap Mouli, Rajan Dhingra, Govind Makharia, Vineet Ahuja
  Intestinal Research.2018; 16(4): 588.     CrossRef
• Risk of infection associated with anti-TNF-α therapy
  Mario Fernández-Ruiz, José María Aguado
  Expert Review of Anti-infective Therapy.2018; 16(12): 939.     CrossRef