Abstract Background Tuberculosis (TB) is often perceived as a frequent complication in Indian patients receiving immunosuppression for Inflammatory Bowel Disease (IBD) probably as it is endemic. This often leads to hesitation among clinicians in prescribing biologics, even when indicated. Reporting actual incidence of latent TB in patients on biologic therapy can help allay apprehensions and guide evidence-based decisions. Methods We conducted a retrospective analysis of 180 patients with inflammatory bowel disease (IBD) treated at a tertiary care center in India. Patient demographics, disease type, and medical therapies including conventional immunomodulators, small-molecule therapies, and biologics were recorded. (Table 1) Biologic therapy details included type, incidence of first biologic failure, and reasons for failure. TB screening results (IGRA+ Chest X-ray+/-Mantoux) prior to biologic initiation were also collected. Descriptive statistics were used to summarize the cohort. Results Among 180 combined pediatric and adult IBD patients (113 males; 62.8%), the mean age was 34.3 ± 16.7 years (Median - 34, Range 3 - 81), 83 (46.1%) had Ulcerative colitis and 97 (53.9%) had Crohn’s disease. The area of residence distributed across urban and rural areas. Biologic therapy was used in 55 patients (30.6%), most commonly infliximab (23, 41.8%), ustekinumab (19, 34.6%), and adalimumab (12, 21.8%); vedolizumab was used in one patient (1.8%). Screening for latent TB prior to biologic initiation was positive in 3/55 patients (5.5%), all of whom received prophylactic therapy, and none developed reactivation. Only one biologic user, a middle-aged male with Crohn’s disease on anti-TNF-alpha, with initial negative TB testing, developed miliary TB during treatment, and successfully managed with standard anti-tubercular therapy after biologic withdrawal. No reactivation was reported with other advanced therapies. Conclusion The incidence of latent TB in IBD patients at our centre was comparable to western population. TB reactivation among patients receiving biologics in this cohort was also low (2%). With robust TB screening and careful monitoring, biologic therapy can be safely started and continued even in TB endemic areas such as India. Biologics should not be withheld when indicated due to perceived fears. Newer therapies appear to be safer and can be considered in areas where burden of TB is high. Conflict of interest: Ashok S, Shalini: No conflict of interest Dr. Chamarthi, Govind Datta: No conflict of interest Shankar, Sahana: No conflict of interest Mohan B V, Murali: No conflict of interest Ranganatha, Ranganatha: No conflict of interest Shivaji, Uday Nagesh: No conflict of interest
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