OBJECTIVES Infliximab (IFX) or adalimumab (ADA) use in patients with inflammatory bowel disease (IBD) leads to increased risk of tuberculosis (TB). This meta-analysis evaluated the factors which determine this risk, with special focus on local TB incidence. METHODS All studies until January 31, 2019, which reported the development of TB in patients with IBD on IFX/ADA, were included after searching PubMed and Embase. Data regarding disease type, number of patients on IFX/ADA, number of patients who developed TB, mean age at IFX/ADA initiation, median duration of development of TB, and latent TB (LTB) were extracted. The details on local TB incidence were obtained from the World Health Organization database, and the studies were stratified into low (<10/100,000), intermediate (10-40/100,000), and high TB burden countries (>40/100,000). Random effect meta-analysis was performed to calculate the overall pooled prevalence and prevalence based on local TB burden. RESULTS Of 130,114 patients (128 studies), 373 developed TB (pooled prevalence: 0.08% [95% confidence interval {CI}: 0.05%-0.10%]). The risk increased with increasing TB burden, pooled prevalence being 0.02% (95% CI: 0.02%-0.03%), 0.21% (95% CI: -0.02% to 0.43%), and 1.59% (95% CI: 1.19%-2.00%) for low, intermediate, and high TB burden countries, respectively. Seventy-three percent of patients who developed TB had no evidence of LTB on screening, the proportion being independent of TB burden. There was no effect of disease or treatment type, study type, gender, age at IFX/ADA initiation, and follow-up duration on TB prevalence. DISCUSSION TB risk in patients with IBD on IFX/ADA depends on the local TB burden and is independent of disease/treatment type.

中文翻译：

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英夫利昔单抗或阿达木单抗治疗炎症性肠病患者的结核病风险取决于结核病的局部疾病负担

目标 炎症性肠病 (IBD) 患者使用英夫利昔单抗 (IFX) 或阿达木单抗 (ADA) 会增加患结核病 (TB) 的风险。这项荟萃分析评估了决定这种风险的因素，特别关注当地结核病的发病率。方法 直到 2019 年 1 月 31 日，所有报告 IFX/ADA 治疗的 IBD 患者发生 TB 的研究都在搜索 PubMed 和 Embase 后被纳入。提取了有关疾病类型、IFX/ADA 患者数量、发展为 TB 的患者数量、IFX/ADA 开始时的平均年龄、TB 发展的中位持续时间和潜伏性 TB (LTB) 的数据。当地结核病发病率的详细信息来自世界卫生组织数据库，并将研究分层为低（<10/100,000）、中等（10-40/100,000）和高结核病负担国家（>40/100,000）。进行随机效应荟萃分析以计算基于当地结核病负担的总体汇总患病率和患病率。结果 在 130,114 名患者（128 项研究）中，373 名发展为 TB（合并患病率：0.08% [95% 置信区间 {CI}：0.05%-0.10%]）。风险随着结核病负担的增加而增加，汇总流行率为 0.02%（95% CI：0.02%-0.03%）、0.21%（95% CI：-0.02% 至 0.43%）和 1.59%（95% CI：1.19%） -2.00%) 分别用于低、中和高结核病负担国家。73% 的结核病患者在筛查时没有 LTB 的证据，这一比例与结核病负担无关。疾病或治疗类型、研究类型、性别、IFX/ADA 开始时的年龄和随访时间对结核病患病率没有影响。