Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: comparison of an interferon-γ release assay vs. tuberculin skin test

Laffitte, Emmanuel; Janssens, Jean–Paul; Roux‐Lombard, Pascale; Thielen, A.-M.; Barde, C.; Marazza, G.; Panizzon, Renato G.; Saurat, Jean‐Hilaire

doi:10.1111/j.1365-2133.2009.09331.x

Cited by 97 publications

(80 citation statements)

References 8 publications

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“…This was similar to previous reports [33]. As the TST cut-off value was elevated to 10 mm, the false-positive results were reduced remarkably and hence the overall agreement was enhanced (88.2%, There also exists a limitation that the 1 TU dose of PPD we used in this study decreases the sensitivity of TST, although effectively reducing false-positive results.…”

Section: Discussionsupporting

confidence: 86%

A T-cell-based enzyme-linked immunospot assay for tuberculosis screening in Chinese patients with rheumatic diseases receiving infliximab therapy

Xie

Chen

et al. 2010

Clin Exp Med

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Anti-tumour necrosis factor-α (TNF-α) therapy brought new hopes for treating rheumatic diseases but also increased the risk of infection, including mycobacterium tuberculosis (MTb). Conventional screening tools, such as tuberculin skin test (TST), lack sensitivity or specificity. Recently, T-SPOT.TB has been introduced to detect tuberculosis infection. Reports have proved its superior performance in detecting tuberculosis infection in various patient populations than the TST. To compare the value of a T-cell-based enzyme-linked immunospot assay (ELISPOT) T-SPOT.TB and conventional (TST) in screening and monitoring tuberculosis in patients with rheumatic diseases during infliximab therapy in China. Fifty-eight patients with various rheumatic diseases who received infliximab therapy were enrolled in the trial. Freshly isolated peripheral blood mononuclear cells were stimulated with MTb-specific antigens (ESAT-6 and CFP10), and IFN-γ-producing cells were counted. TST was performed with 1 TU PPD injected intradermally into the volar aspect of forearm. A cutaneous induration with diameter ≥5 mm was considered as positive TST, and an increment ≥5 mm of cutaneous induration was considered as TST conversion. TST and T-SPOT.TB test were carried out at baseline and repeated 12 months after infliximab therapy (if no active TB occurs) or at times when TB occurred. Moreover, all patients were initially evaluated for latent tuberculosis infection (LTBI) with clinical examination and chest radiograph. The McNemar test was used for TST and T-SPOT.TB concordance analysis. Cohen's kappa coefficient was used to assess strength of the agreement. Among the 58 patients evaluated, 25 (43.1%) had ankylosing spondylitis, 24 (41.4%) had rheumatoid arthritis, 4 (6.9%) had undifferentiated spondyloarthropathy, 3 (5.2%) had psoriatic arthritis and 2 (3.4%) had reactive arthritis. A total of 52 patients (89.7%) had previously received vaccination with Bacille Calmette-Guerin. All of the patients received either single or combination of disease modifying anti-rheumatic drug (DMARDs) therapy, and 16 (27.4%) had previously or presently received glucocorticoid therapy. Before infliximab therapy, 12 patients (20.7%) had positive and 46 (79.3%) had negative TST results, and only 1 (1.7%) had positive T-SPOT.TB. Among 51 patients completing the repeated TST and T-SPOT.TB assay, 7 patients (13.7%) had TST conversion and 4 (7.8%) had positive T-SPOT.TB results. Of 7 patients with TST conversion, 2 patients (28.6%) developed active TB and also had positive T-SPOT.TB results; of 44 patients with no TST conversion, 2 patients (4.5%) had positive T-SPOT.TB and 1 (2.3%) had active TB. If 5 mm was used as the cut-off value of TST, TST and T-SPOT.TB, had an agreement value of 68.6% with a kappa value of 0.166. If 10 mm was used as the cut-off value, the agreement between TST and T-SPOT.TB was 88.2% with a kappa value of 0.338. T-SPOT.TB was more specific than TST in detecting tuberculosis during infliximab therapy in China with high BCG vaccination and high ...

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Section: Discussionsupporting

confidence: 86%

A T-cell-based enzyme-linked immunospot assay for tuberculosis screening in Chinese patients with rheumatic diseases receiving infliximab therapy

Xie

Chen

et al. 2010

Clin Exp Med

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“…Furthermore, data regarding the rate of progression to TB in immunocompromised patients who are IGRA negative and TST positive without LTBI treatment are still limited. In a recent study from Switzerland, 10 vaccinated patients with psoriasis who tested TST positive and T-SPOT.TB assay negative were treated with anti-TNF agents for 64 weeks without TB reactivation (22).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Two Gamma Interferon Release Assays and Tuberculin Skin Testing for Tuberculosis Screening in a Cohort of Patients with Rheumatic Diseases Starting Anti-Tumor Necrosis Factor Therapy

Vassilopoulos

Tsikrika

Hatzara

et al. 2011

Clin Vaccine Immunol

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Gamma interferon release assays (IGRAs) are increasingly used for latent Mycobacterium tuberculosis infection (LTBI) screening in patients with rheumatic diseases starting anti-tumor necrosis factor (anti-TNF) therapies. We compared the performances of two IGRAs, an enzyme-linked immunospot release assay (T-SPOT.TB) and an enzyme-linked immunosorbent assay (QuantiFERON-TB Gold In Tube [QFT-GIT]), to that of tuberculin skin testing (TST) for LTBI screening of 157 consecutive rheumatic patients starting anti-TNF therapies. Among 155 patients with valid results, 58 (37%) were positive by TST, 39 (25%) by T-SPOT.TB assay, and 32 (21%) by QFT-GIT assay. IGRAs were associated more strongly with at least one risk factor for tuberculosis (TB) than TST. Risk factors for a positive assay included chest X-ray findings of old TB (TST), advanced age (both IGRAs), origin from a country with a high TB prevalence, and a positive TST (T-SPOT.TB assay). Steroid use was negatively associated with a positive QFT-GIT assay. The agreement rate between IGRAs was 81% (kappa rate ‫؍‬ 0.47), which was much higher than that observed between an IGRA and TST. If positivity by either TST or an IGRA was required for LTBI diagnosis, then the rate of LTBI would have been 46 to 47%, while if an IGRA was performed only for TST-positive patients, the respective rate would have been 11 to 17%. In conclusion, IGRAs appear to correlate better with TB risk than TST and should be included in TB screening of patients starting anti-TNF therapies. In view of the high risk of TB in these patients, a combination of one IGRA and TST is probably more appropriate for LTBI diagnosis.The accurate diagnosis of latent Mycobacterium tuberculosis infection (LTBI) is critical for patients with various autoimmune diseases who are starting anti-tumor necrosis factor (anti-TNF) therapies, since the majority of tuberculosis (TB) cases developing in this population are due to LTBI reactivation (1.5 to 4 times increased risk) (18)(19)(20). Traditional methods for LTBI diagnosis, such as the tuberculin skin test (TST), have well-known limitations regarding their sensitivity and specificity for LTBI diagnosis (18)(19)(20). Over the last decade, different gamma interferon (IFN-␥) release assays (IGRAs) have been approved for LTBI diagnosis (13). These assays detect IFN-␥ secreted by peripheral mononuclear cells after in vitro stimulation with specific M. tuberculosis antigens not present in the M. bovis bacillus Calmette-Guérin (BCG) vaccine, either by enzyme-linked immunosorbent assay (ELISA) (QuantiFERON-TB Gold [QFT-G] and QuantiFERON-TB Gold In Tube [QFT-GIT] assays; Cellestis Limited, Carnegie, Victoria, Australia) or by enzyme-linked immunospot assay (T-SPOT.TB assay; Oxford Immunotec, Oxford, United Kingdom). Newer techniques for the diagnosis of LTBI or active TB based on the secretion of IFN-␥ after specific stimulation with specific M. tuberculosis antigens, such as the heparinbinding hemagglutinin (HBHA), have also shown promising results (28).Although there have b...

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“…Para tentar melhorar a acurácia dos testes cutâneos, novas técnicas vêm sendo testadas ainda em caráter experimental 6,11,[13][14][15] .…”

Section: Discussionunclassified

Tuberculose pleural após uso de adalimumabe na doença de Crohn: relato de caso

Batista

Toledo

Albuquerque

et al. 2011

Rev bras. colo-proctol.

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IC, FORmIgA gJS. Tuberculose pleural após uso de adalimumabe na doença de Crohn: relato de caso. Rev bras Coloproct, 2011;31(1): 85-88. RESUMO: O tratamento da doença deCrohn perineal é feito pela combinação da terapia medicamentosa e da cirúrgica. A terapia biológica é importante devido à eficácia clínica na indução e manutenção de remissão da doença. No entanto, devido à ação imunomoduladora e imunossupressora, o uso de biológicos como infliximabe e adalimumabe eleva o risco de infecções oportunistas. Relatou-se o caso de paciente feminino, 28 anos, diagnosticada com doença de Crohn perineal, em uso de azatioprina e adalimumabe. Há sete dias com tosse seca, febre vespertina e dispneia. Ao exame físico, febril, desidratada, diminuição do murmúrio vesicular nos campos médio e inferior do hemitoráx direito e cicatriz de fistulotomia anorretal sem sinais flogísticos. A radiografia de tórax mostrou derrame pleural em hemitórax direito, e a análise do líquido pleural constatou adenosina deaminase elevada, nível de glicose normal e citologia diferencial com 88% de monomorfonucleares. Foi estabelecido o diagnóstico de tuberculose pleural, e a paciente foi medicada com esquema tríplice (rifampicina, isoniazida e pirazinamida) por seis meses associada à prednisona 40 mg/dia, por um mês, com posterior desmame do corticoide. Atualmente, encontra-se assintomática e em uso de ciprofloxina 1 g/dia para a doença de Crohn perineal. O tratamento da DC perineal (DCP) alcança melhores resultados ao associar terapia medicamentosa e cirúrgica. Dos medicamentos utilizados, destaca-se a terapia biológica devido à eficácia clínica na indução e manutenção de remissão da doença [1][2][3][4][5] . no entanto, ao neutralizar o fator de necrose tumoral alfa (TNF-α), exercendo, por isso, ação imunomoduladora e imussupressora, o uso de biológicos como infliximabe e adalimumabe eleva o risco de infecções oportunistas 1,2,6 . PalavrasO objetivo deste trabalho é relatar um caso de tuberculose (TB) pleural secundária ao uso de adalimumabe para o tratamento da DCP complexa.

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Tuberculosis screening in patients with psoriasis before antitumour necrosis factor therapy: comparison of an interferon-γ release assay vs. tuberculin skin test

Abstract: This study is the first to underline the frequency of LTBI in patients with psoriasis (20%), and to support the use of IGRA instead of the TST for its detection. Nevertheless, there is still a risk of tuberculosis under anti-TNF therapy, even if LTBI is correctly diagnosed and treated.

Cited by 97 publications

References 8 publications

A T-cell-based enzyme-linked immunospot assay for tuberculosis screening in Chinese patients with rheumatic diseases receiving infliximab therapy

A T-cell-based enzyme-linked immunospot assay for tuberculosis screening in Chinese patients with rheumatic diseases receiving infliximab therapy

Comparison of Two Gamma Interferon Release Assays and Tuberculin Skin Testing for Tuberculosis Screening in a Cohort of Patients with Rheumatic Diseases Starting Anti-Tumor Necrosis Factor Therapy

Tuberculose pleural após uso de adalimumabe na doença de Crohn: relato de caso

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