Prognostic value of interferon-γ release assays, a population-based study from a TB low-incidence country

Hermansen, Thomas Stig; Lillebæk, Troels; Kristensen, Kristina Langholz; Andersen, Peter Henrik; Ravn, Pernille

doi:10.1136/thoraxjnl-2015-208228

Cited by 13 publications

(10 citation statements)

References 30 publications

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“…The TB IR of 11.1/1000 person-years in QFT-positive individuals in the current study is in the lower range of IRs reported in previous meta-analyses (4–4827 and 3.7–84.5 2 /1000 person-years in IGRA-positive individuals), and higher than in a recent Danish population-based study (3.8/1000 person-years) 9. The NNT in QFT positivity was similar to a European study on TB contacts,15 but lower than reported in the Danish study 9 28…”

Section: Discussioncontrasting

confidence: 68%

“…The overall PPV of 2.2% from the full study period was comparable to the 1.9%15and 1.32%9 reported from other low-incidence countries, and lower than the pooled PPV of 2.7% reported in a meta-analysis 29. Direct comparison is difficult, given differences in study designs, populations and follow-up periods.…”

Section: Discussionmentioning

confidence: 47%

“…In the main analysis, we defined incident TB as sample collection for TB diagnosis >3 months after QFT testing, in line with previous studies 9. As some cases identified in this manner may represent co-prevalent TB, we conducted a sensitivity analysis with the threshold for incident TB set at 6 months after QFT testing.…”

Section: Methodsmentioning

confidence: 99%

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Stratification by interferon-γ release assay level predicts risk of incident TB

Winje

White

Syre

et al. 2018

Thorax

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 47%

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Stratification by interferon-γ release assay level predicts risk of incident TB

Winje

White

Syre

et al. 2018

Thorax

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“…Within the subset of 18 studies, several compared the frequency of TB disease between IGRA-positive and IGRA-negative participants, consistently finding that rates, hazards or odds of TB were higher among the former (although CIs sometimes crossed the null value). Unadjusted estimates included a hazard ratio of 4.0 (95% CI 0.8 to 19.3), 36 odds ratio of 2.10 (95% CI 0.13 to 34.4) 35 and rate ratios of 8.5 (no CI given), 34 2.9 (95% CI 2.8 to 21. 41 Adjusted values included a hazard ratio of 2.0 (95% CI 1.2 to 3.3), after adjustment for BCG vaccination scar, maternal education and current/prior household TB contact, 54 and an odds ratio of 14.9 (95% CI 2.77 to 80.3), adjusted for the number of IGRA-positive contacts of the same index case, receipt of treatment and place of contact (household vs. other).…”

Section: Diagnostic Performance Of Interferon Gamma Release Assays Fomentioning

confidence: 99%

Two interferon gamma release assays for predicting active tuberculosis: the UK PREDICT TB prognostic test study

Abubakar

Lalvani

Southern

et al. 2018

Health Technol Assess

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Background Despite a recent decline in the annual incidence of tuberculosis (TB) in the UK, rates remain higher than in most Western European countries. The detection and treatment of latent TB infection (LTBI) is an essential component of the UK TB control programme. Objectives To assess the prognostic value and cost-effectiveness of the current two interferon gamma release assays (IGRAs) compared with the standard tuberculin skin test (TST) for predicting active TB among untreated individuals at increased risk of TB: (1) contacts of active TB cases and (2) new entrants to the UK from high-TB-burden countries. Design A prospective cohort study and economic analysis. Participants and setting Participants were recruited in TB clinics, general practices and community settings. Contacts of active TB cases and migrants who were born in high-TB-burden countries arriving in the UK were eligible to take part if they were aged ≥ 16 years. Main outcome measures Outcomes include incidence rate ratios comparing the incidence of active TB in those participants with a positive test result and those with a negative test result for each assay, and combination of tests and the cost per quality-adjusted life-year (QALY) for each screening strategy. Results A total of 10,045 participants were recruited between May 2010 and July 2015. Among 9610 evaluable participants, 97 (1.0%) developed active TB. For the primary analysis, all test data were available for 6380 participants, with 77 participants developing active TB. A positive result for TSTa (positive if induration is ≥ 5 mm) was a significantly poorer predictor of progression to active TB than a positive result for any of the other tests. Compared with TSTb [positive if induration is ≥ 6 mm without prior bacillus Calmette–Guérin (BCG) alone, T-SPOT®.TB (Oxford Immunotec Ltd, Oxford, UK), TSTa + T-SPOT.TB, TSTa + IGRA and the three combination strategies including TSTb were significantly superior predictors of progression. Compared with the T-SPOT.TB test alone, TSTa + T-SPOT.TB, TSTb + QuantiFERON® TB Gold In-Tube (QFT-GIT; QIAGEN GmbH, Hilden, Germany) and TSTb + IGRA were significantly superior predictors of progression and, compared with QFT-GIT alone, T-SPOT.TB, TSTa + T-SPOT.TB, TSTa + QFT-GIT, TSTa + IGRA, TSTb + T-SPOT.TB, TSTb + QFT-GIT and TSTb + IGRA were significantly superior predictors of progression. When evaluating the negative predictive performance of tests and strategies, negative results for TSTa + QFT-GIT were significantly poorer predictors of non-progression than negative results for TSTa, T-SPOT.TB and TSTa + IGRA. The most cost-effective LTBI testing strategies are the dual-testing strategies. The cost and QALY differences between the LTBI testing strategies were small; in particular, QFT-GIT, TSTb + T-SPOT.TB and TSTb + QFT-GIT had very similar incremental net benefit estimates. Conclusion This study found modest differences between tests, or combinations of tests, in identifying individuals who would go on to develop active TB. However, a two-step approach that combined TSTb with an IGRA was the most cost-effective testing option. Implications for practice and future research The two-step TSTb strategy, which stratified the TST by prior BCG vaccination followed by an IGRA, was the most cost-effective approach. The limited ability of current tests to predict who will progress limits the clinical utility of tests. The implications of these results for the NHS England/Public Health England national TB screening programme for migrants should be investigated. Study registration This study is registered as NCT01162265. Funding The National Institute for Health Research Health Technology Assessment programme.

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“…Hermansen et al 7 report results from a large 5-year nationwide retrospective registry study comprising 15 980 individuals with a minimum of 2 years follow-up. The study is remarkable for including almost all individuals in Denmark who had an IGRA test (QuantiFERON-TB Gold In-Tube test (QFT)) performed during the study period.…”

mentioning

confidence: 99%