1. Rate of De Novo TB Infection in an IBD Population Treated with Adalimumab in Brazil
 Cury, Didia B.1, 2; Moss, Alan C.2; de Oliveira, Rogério A.3
Inflammatory Bowel Disease Center, Scope Clinic, Campo Grande, MS, Brazil. 
Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States. 
3. Biostatistics, UNESP, Botucatu, São Paulo/SP, Brazil. 

2. Disclosures AC Moss has received consulting fees from
Abbott and Janssen.
D Cury has received travel arrangements
from Abbvie.

3. Introduction
Screening for latent TB prior to anti-TNF therapy has reduced the rates of TB reactivation in patients with IBD.
In recent years the incidence of TB has increased in specific populations in Brazil.
The goal of this study was to report the rate of de novo TB infections in the Midwest of Brazil during treatment with adalimumab.

4. Material and Methods
Prospective observational study in a single center.
All subjects starting adalimumab for IBD underwent screening for latent TB with PPD testing and CXR .
Surveillance for adverse events was performed for 12 months, with annual PPD and CXR.

5. Results
Seventy-seven patients starting adalimumab were enrolled in this cohort (73 with Crohn's disease and 4 with ulcerative colitis).
36% were anti-TNF naive, 34% were anti-TNF exposed, and 22% were immunomodulator exposed when starting adalimumab (Figure 1).
All enrollees had a negative PPD test and normal CXR at enrollment.

6. Figure 1

7. Results
Three patients were diagnosed with new TB infections over 12 months follow-up (4% annual rate).
Two were cutaneous (diagnosed by skin biopsy) (Figure 2), and one pulmonary.
Both patients resumed Adalimumab after > 6 months of anti-tuberculous therapy.
No patients developed a positive PPD beyond these three cases .

8. Figure 2

10. Conclusions
Patients treated with anti-TNFs in endemic populations remain at risk of TB infections
Physicians should remain vigilant for this development