QuantiFERON-TB Gold In-Tube Test in the Diagnosis of Latent Tuberculosis Infection in Arthritis Patients Treated with Tumor Necrosis Factor Antagonists

Abstract

SUMMARY -Th e aim of this study was to investigate the role of the QuantiFERON-TB Gold In-Tube test (QFT-GIT) in detecting latent tuberculosis in immunocompromised patients before introducing tumor necrosis factor (TNF-α) antagonists. Th e study included 300 subjects of similar age. Th e study group comprised of 150 QuantiFERON (QFT) positive subjects with rheumatoid arthritis, Crohn's disease, ulcerative colitis, ankylosing spondylitis and psoriatic arthritis, while control group comprised of 150 QFT negative respondents with the same diseases. Exhaustive medical history was documented for all patients. Screening tests were performed including QFT-GIT, tuberculin skin test (TST), chest radiography and detection of Mycobacterium tuberculosis in sputum culture 2 times. A positive QFT-GIT test result, regardless of TST result, was considered as an indication for latent tuberculosis infection (LTBI) treatment. Results of this study showed good correlation between the conclusive results of QFT-GIT and TST. All study group patients had normal clinical fi ndings, normal radiologic fi ndings and negative results of sputum microbiological analysis during the course of prophylaxis and after its completion and during the course of biological therapy. Conversion of positive QFT-GIT test to negative was observed in 4% of study group patients, while QFT negative respondents remained negative. Th ere was a statistically signifi cant positive correlation between QFT-GIT, TST results and patient age, smoking habit and contact with tuberculosis. Study results showed that along with good clinical evaluation and detailed medical history, it is important to conduct testing in order to avoid disease progression or unnecessary isoniazid prophylaxis.

Tuberculin test conversion in patients with chronic inflammatory arthritis receiving biological therapy

“…Some limitations to our study include the lack of QuantiFERON test given its high cost. However, although some studies have shown greater sensitivity of this method compared to TST, the difference was not significant in a recent study (27). Second, all patients with a TST conversion received isoniazid, not knowing what would had happened if these patients did not receive the recommended prophylaxis.…”

An updated systematic review on the applied TST and IGRA Test for diagnosing LTBI in patients treated with TNF-α inhibitor drugs

“…Çekiç et al, (2015) indicated the percentage of active TB in IBD patients was observed between QFT-GIT and TST results. Positive QFT-GIT test converted to negative in 4% of patients, while QFT negative was not changed[34]. Characteristic of selected studiesAbreu et al (2017) screened LTBI by TST and two different IGRAs assays [QFT-GIT and T-SPOT.TB] in IBD patients under anti-TNF-α therapy for 26 months.…”