Effect of immunosuppressive therapy on interferon γ release assay for latent tuberculosis screening in patients with autoimmune diseases: a systematic review and meta-analysis

Abstract

ObjectiveInterferon γ release assay (IGRA) is commonly used to diagnose latent TB infection (LTBI). Immunosuppressive therapy may affect its performance but data are conflicting. We aimed to determine the effect of immunosuppressive therapy on the performance of IGRA in patients with autoimmune diseases.MethodsWe searched PubMed, MEDLINE, EMBASE and the Cochrane Library up to December 2014. We included studies that reported the IGRA results in patients with autoimmune disease with or without immunosuppressive therapy. The pooled effect of immunosuppressive therapy on IGRA was estimated using a Peto fixed-effects model.ResultsWe included 17 studies with 3197 participants in the meta-analysis. Among the subjects, 71.5% were taking immunosuppressive therapy and 56.7% had received Bacillus Calmette–Guérin vaccination. Compared with patients not on immunosuppressants, patients receiving immunosuppressive therapy were less likely to have a positive IGRA result (OR 0.66, 95% CI 0.53 to 0.83, I2=23%), especially patients receiving anti-tumour necrosis factor (anti-TNF) treatment (OR 0.50, 95% CI 0.29 to 0.88). The use of immunosuppressive therapy was also associated with a lower rate of positive tuberculin skin test result (OR 0.51, 95% CI 0.42 to 0.61).ConclusionsOur meta-analysis showed that IGRA results are negatively affected by immunosuppressive therapy. IGRA alone may not be sufficiently sensitive to diagnose LTBI in patients on immunosuppressive therapy. Patients should preferably be screened for LTBI before initiation of immunosuppressive therapy, especially before anti-TNF therapy.

Corticosteroids and infliximab impair the performance of interferon-γ release assays used for diagnosis of latent tuberculosis

“…A recent meta-analysis further supports immunosuppressive drugs interfering with IGRAs 9. Patients receiving corticosteroids or anti-TNF-α agents had significantly lower rates of positive IGRA results than those not treated with these agents.…”

Challenges in screening for latent tuberculosis in inflammatory bowel disease prior to biologic treatment: a UK cohort study

“…Although specificity for diagnosing LTBI using IGRAs is reported as 95%, there are issues around reproducibility and indeterminacy of test results 5. Indeterminate results can occur in 2% of the healthy population,5 and in up to 12% of immunocompromised or immunosuppressed patients 6.…”

“…Indeterminate results can occur in 2% of the healthy population,5 and in up to 12% of immunocompromised or immunosuppressed patients 6. While it is known that concomitant treatment with steroids can affect IGRA test results, less is known about the effects of other immunosuppressive medications.…”

What defines latent infection with Mycobacterium tuberculosis in patients with autoimmune diseases?

“…In this issue of the journal, Wong et al 5 report their results of a systematic review and meta-analysis on the effect of immunosuppressive drug treatment on LTBI testing in patients with autoimmune diseases. Studies were included where the two commercially available IGRA tests, the QuantiFERON-TB gold in tube assay (QFT) or the T-SPOT.…”

“…The percentage of positive test results in the TST and the two IGRA, the QuantiFERON TB gold in tube assay (QFT) or the T-SPOT. TB assay, was calculated from data derived from the meta-analysis by Wong et al 5 and compared with patients with rheumatoid arthritis (RA) and other patients with immunodeficiencies such as chronic renal failure (CRF), HIV-infected patients (HIV), solid organ transplant recipients (SOTs) or stem cell transplant recipients (SCTs). Data from patients with RA, CRF, HIV, SOT and SCT were reproduced from a recent TBnet study, and data sets are displayed from patients where the TST and the two IGRA results were available 6.…”