Limits...
QuantiFERON-TB Gold In-Tube assay for screening arthritis patients for latent tuberculosis infection before starting anti-tumor necrosis factor treatment.

Lee H, Park HY, Jeon K, Jeong BH, Hwang JW, Lee J, Cha HS, Koh EM, Kang ES, Koh WJ - PLoS ONE (2015)

Bottom Line: Bacillus Calmette-Guérin scars were found in 236 (69.0%) patients.TB did not occur in 62 TST+/QFT+ patients who received LTBI treatment.TB incidence rate during the follow-up period did not differ among TST-/QFT+, TST+/QFT-, and TST-/QFT- patients (P = 0.661).

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background: Patients undergoing anti-tumor necrosis factor (TNF) treatment are at an increased risk of reactivating a latent tuberculosis infection (LTBI). This study evaluated the effectiveness of the QuantiFERON-TB Gold In-Tube (QFT) assay for diagnosing LTBI in arthritis patients undergoing anti-TNF treatment.

Methods: We enrolled 342 consecutive patients from August 2007 to October 2013: 176 (51.5%) patients with ankylosing spondylitis and 166 (48.5%) with rheumatoid arthritis. Screening tests included tuberculin skin test (TST) and QFT assay. Positive QFT results, regardless of TST results, were considered an indicator for LTBI treatment.

Results: Bacillus Calmette-Guérin scars were found in 236 (69.0%) patients. Of 342 patients, TST and QFT were positive in 122 (35.7%) and 103 (30.1%) patients, respectively, and discordant in 101 (29.5%) patients. During a median follow-up duration of 41.7 months, five patients (1.5%) developed TB in a median of 20.8 months after initiation of anti-TNF treatment (428/100,000 person-years). TB did not occur in 62 TST+/QFT+ patients who received LTBI treatment. Of 41 TST-/QFT+ patients who received LTBI treatment, one (2.4%) developed TB 20.5 months after starting anti-TNF treatment (705/100,000 person-years). Of 60 TST+/QFT- patients who did not receive LTBI treatment, two (3.3%) developed TB 20.8 and 22.0 months after starting anti-TNF treatment (871/100,000 person-years). Of 179 TST-/QFT- patients, two (1.1%) developed TB 7.2 and 22.7 months, respectively, after initiating anti-TNF treatment (341/100,000 person-years). TB incidence rate during the follow-up period did not differ among TST-/QFT+, TST+/QFT-, and TST-/QFT- patients (P = 0.661).

Conclusion: QFT might be used instead of TST for diagnosing LTBI in patients before starting anti-TNF therapy in countries, such as Korea, where the TB prevalence is intermediate and the BCG vaccination is mandatory at birth. In the absence of a true gold standard test for LTBI, however, there is still a risk of TB development during anti-TNF treatment.

No MeSH data available.


Related in: MedlinePlus

The proportion of tuberculosis-free patients with TST+/QFT− (dotted line), TST−/QFT+ (dashed line) and TST−/QFT− results (solid line) in Kaplan-Meier curves.QFT = QuantiFERON-TB Gold In-Tube; TST = tuberculin skin test.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4352032&req=5

pone.0119260.g002: The proportion of tuberculosis-free patients with TST+/QFT− (dotted line), TST−/QFT+ (dashed line) and TST−/QFT− results (solid line) in Kaplan-Meier curves.QFT = QuantiFERON-TB Gold In-Tube; TST = tuberculin skin test.

Mentions: The median follow-up durations after initiation of anti-TNF treatment was 38.5 months (IQR 19.2–58.6 months) in the TST−/QFT− patients, 44.8 months (IQR 32.8–58.6 months) in the TST+/QFT− patients and 48.3 months (IQR 19.6–60.8 months) in the TST−/QFT+ patients. TB incidence rate during the follow-up period was not different among TST−/QFT− patients, TST+/QFT− patients and TST−/QFT+ patients (P = 0.661, Fig. 2), which remained consistent even after adjustments were made for age, sex, BCG scars, TB treatment history, underlying diseases and use of immunosuppressant drugs (P = 0.673).


QuantiFERON-TB Gold In-Tube assay for screening arthritis patients for latent tuberculosis infection before starting anti-tumor necrosis factor treatment.

Lee H, Park HY, Jeon K, Jeong BH, Hwang JW, Lee J, Cha HS, Koh EM, Kang ES, Koh WJ - PLoS ONE (2015)

The proportion of tuberculosis-free patients with TST+/QFT− (dotted line), TST−/QFT+ (dashed line) and TST−/QFT− results (solid line) in Kaplan-Meier curves.QFT = QuantiFERON-TB Gold In-Tube; TST = tuberculin skin test.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352032&req=5

pone.0119260.g002: The proportion of tuberculosis-free patients with TST+/QFT− (dotted line), TST−/QFT+ (dashed line) and TST−/QFT− results (solid line) in Kaplan-Meier curves.QFT = QuantiFERON-TB Gold In-Tube; TST = tuberculin skin test.
Mentions: The median follow-up durations after initiation of anti-TNF treatment was 38.5 months (IQR 19.2–58.6 months) in the TST−/QFT− patients, 44.8 months (IQR 32.8–58.6 months) in the TST+/QFT− patients and 48.3 months (IQR 19.6–60.8 months) in the TST−/QFT+ patients. TB incidence rate during the follow-up period was not different among TST−/QFT− patients, TST+/QFT− patients and TST−/QFT+ patients (P = 0.661, Fig. 2), which remained consistent even after adjustments were made for age, sex, BCG scars, TB treatment history, underlying diseases and use of immunosuppressant drugs (P = 0.673).

Bottom Line: Bacillus Calmette-Guérin scars were found in 236 (69.0%) patients.TB did not occur in 62 TST+/QFT+ patients who received LTBI treatment.TB incidence rate during the follow-up period did not differ among TST-/QFT+, TST+/QFT-, and TST-/QFT- patients (P = 0.661).

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background: Patients undergoing anti-tumor necrosis factor (TNF) treatment are at an increased risk of reactivating a latent tuberculosis infection (LTBI). This study evaluated the effectiveness of the QuantiFERON-TB Gold In-Tube (QFT) assay for diagnosing LTBI in arthritis patients undergoing anti-TNF treatment.

Methods: We enrolled 342 consecutive patients from August 2007 to October 2013: 176 (51.5%) patients with ankylosing spondylitis and 166 (48.5%) with rheumatoid arthritis. Screening tests included tuberculin skin test (TST) and QFT assay. Positive QFT results, regardless of TST results, were considered an indicator for LTBI treatment.

Results: Bacillus Calmette-Guérin scars were found in 236 (69.0%) patients. Of 342 patients, TST and QFT were positive in 122 (35.7%) and 103 (30.1%) patients, respectively, and discordant in 101 (29.5%) patients. During a median follow-up duration of 41.7 months, five patients (1.5%) developed TB in a median of 20.8 months after initiation of anti-TNF treatment (428/100,000 person-years). TB did not occur in 62 TST+/QFT+ patients who received LTBI treatment. Of 41 TST-/QFT+ patients who received LTBI treatment, one (2.4%) developed TB 20.5 months after starting anti-TNF treatment (705/100,000 person-years). Of 60 TST+/QFT- patients who did not receive LTBI treatment, two (3.3%) developed TB 20.8 and 22.0 months after starting anti-TNF treatment (871/100,000 person-years). Of 179 TST-/QFT- patients, two (1.1%) developed TB 7.2 and 22.7 months, respectively, after initiating anti-TNF treatment (341/100,000 person-years). TB incidence rate during the follow-up period did not differ among TST-/QFT+, TST+/QFT-, and TST-/QFT- patients (P = 0.661).

Conclusion: QFT might be used instead of TST for diagnosing LTBI in patients before starting anti-TNF therapy in countries, such as Korea, where the TB prevalence is intermediate and the BCG vaccination is mandatory at birth. In the absence of a true gold standard test for LTBI, however, there is still a risk of TB development during anti-TNF treatment.

No MeSH data available.


Related in: MedlinePlus