Role of interferon-gamma release assays (IGRAs) for the screening of latent tuberculosis infection in patients candidates for TNF-α antagonist


Submitted: 14 February 2014
Accepted: 14 February 2014
Published: 30 June 2010
Abstract Views: 755
PDF: 671
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Background: Tumor necrosis factor-α (TNF-a) inhibitors are associated with an increased risk of reactivation of latent tuberculosis infection (LTBI); thus, the guidelines recommends TB screening for all patients before starting anti-TNF-α therapy.The use of tuberculin skin test (TST) is controversial because of the immunosuppressive treatment may lead to false-negative TST results and previous BCG-vaccination produces false-positive. The introduction in clinical practice of the interferon-gamma release assays (IGRAs) has opened new perspectives for diagnosis of LTBI.The aim of the study was to investigate the performance of QuantiFERON-TB Gold In Tube assay (QFT-GIT) for the diagnosis of LTBI in patients with an immune-mediated inflammatory diseases candidates for anti-TNF-α therapy. Methods:We enrolled 195 patients with rheumatoid arthritis (n=72), psoriatic arthritis (n=40), psoriasis (n=41), ankylosing spondylitis (n=10), Crohn’s disease (n=18), and Behcet’s disease (n=8). Screening included: clinical evaluation, chest X-ray,TST and QFT-GIT. Results: Of the 195 patients, 32 (16.4%), 137 (70.2%) and 26 (13.3%) tested positive, negative and indeterminate with QFT-GIT test, respectively. The level of agreement between two tests was 81.6 % (k=0.55). Among the screened patients, 38 (19%) were considered to have LTBI and received isoniazid treatment, while 31 patients (16%) showed discordant results between two tests. Univariate analysis showed an association between BCG vaccination and discordant TST-positive/QFT-GIT-negative results (OR=6; 95%CI: 2.3-37.1; p<0.001); no association was observed between the immunosuppressive therapy and discordant TST-negative/QFT-GIT-positive results (OR=0.16; 95%CI: 0.01-1.8; p<0.09). Conclusions: Our results suggest that QFT-GIT may be helpful for the diagnosis of LTBI in patients candidates for anti-TNF-α treatment because of its performance seems to not be affected by any type of immunosuppression.

Sauzullo, I., Mengoni, F., Scrivo, R., Valesini, G., Potenza, C., Skroza, N., Lichtner, M., Marocco, R., Vincenzo, V., & Mastroianni, C. M. (2010). Role of interferon-gamma release assays (IGRAs) for the screening of latent tuberculosis infection in patients candidates for TNF-α antagonist. Microbiologia Medica, 25(2). https://doi.org/10.4081/mm.2010.2444

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