Abstract
Background: During screening for latent tuberculosis infection (LTBI), before anti-tumor-necrosis-factor-a treatment, most patients are already
receiving immunosuppressive therapy. The objective was to evaluate the performance of the QuantiFERON Gold In-Tube (QFT-IT) and the
Tuberculin Skin Test (TST).
Methods: A prospective multicenter study included 248 patients with ulcerative colitis (39), Crohn’s disease (54), rheumatoid arthritis (111),
and spondylo-arthropathy (44).
Results: QFT-IT was positive in 7/248 (3%), negative in 229 (92%), and indeterminate in 12 (5%). TST was positive in 54/238 (23%) patients.
Chest x-ray was suspect for tuberculosis in 5/236 (2%), and 35/167 (21%) had 1 risk-factors for infection with Mycobacterium tuberculosis.
The main finding was a pronounced negative effect on QFT-IT and TST performance associated with prednisolone treatment. During prednisolone
treatment interferon gamma (IFN-c) response to mitogen stimulation was impaired (median IFN-c response 4.9 IU/mL; interquartile range
[IQR] 0.8 to 10.0) compared to patients 1) not receiving corticosteroids (median 10.0; IQR 5.0 to 10.0; P ¼ 0.0015) or 2) receiving longacting
corticosteroids (median >10.0; IQR 9.7 to >10.0; P ¼ 0.0058). Prednisolone treatment was strongly associated with negative TST,
adjusted odds ratio (AOR) 0.22 (0.1–0.8; P ¼ 0.018), and with an increased risk of indeterminate QFT-IT results AOR 16.1 (4.1–63.2; P <
0.001), whereas no negative effect was found for long-acting corticosteroids. Doses of 10 mg prednisolone were associated with a 27% risk of
indeterminate results. Single use of azathioprine, methotrexate, or 5-aminosalicylate (5-ASA) did not affect the test results.
Conclusions: Oral prednisolone severely suppressed QFT-IT and TST performance, whereas the long-acting corticosteroids methotrexate, azathioprine,
and 5-ASA did not have a similar detrimental effect. Patients should be screened for LTBI with QFT-IT or TST prior to initiation of
prednisolone therapy and negative QFT-IT or TST results interpreted with caution in patients treated with any corticosteroid until further data
are available.
receiving immunosuppressive therapy. The objective was to evaluate the performance of the QuantiFERON Gold In-Tube (QFT-IT) and the
Tuberculin Skin Test (TST).
Methods: A prospective multicenter study included 248 patients with ulcerative colitis (39), Crohn’s disease (54), rheumatoid arthritis (111),
and spondylo-arthropathy (44).
Results: QFT-IT was positive in 7/248 (3%), negative in 229 (92%), and indeterminate in 12 (5%). TST was positive in 54/238 (23%) patients.
Chest x-ray was suspect for tuberculosis in 5/236 (2%), and 35/167 (21%) had 1 risk-factors for infection with Mycobacterium tuberculosis.
The main finding was a pronounced negative effect on QFT-IT and TST performance associated with prednisolone treatment. During prednisolone
treatment interferon gamma (IFN-c) response to mitogen stimulation was impaired (median IFN-c response 4.9 IU/mL; interquartile range
[IQR] 0.8 to 10.0) compared to patients 1) not receiving corticosteroids (median 10.0; IQR 5.0 to 10.0; P ¼ 0.0015) or 2) receiving longacting
corticosteroids (median >10.0; IQR 9.7 to >10.0; P ¼ 0.0058). Prednisolone treatment was strongly associated with negative TST,
adjusted odds ratio (AOR) 0.22 (0.1–0.8; P ¼ 0.018), and with an increased risk of indeterminate QFT-IT results AOR 16.1 (4.1–63.2; P <
0.001), whereas no negative effect was found for long-acting corticosteroids. Doses of 10 mg prednisolone were associated with a 27% risk of
indeterminate results. Single use of azathioprine, methotrexate, or 5-aminosalicylate (5-ASA) did not affect the test results.
Conclusions: Oral prednisolone severely suppressed QFT-IT and TST performance, whereas the long-acting corticosteroids methotrexate, azathioprine,
and 5-ASA did not have a similar detrimental effect. Patients should be screened for LTBI with QFT-IT or TST prior to initiation of
prednisolone therapy and negative QFT-IT or TST results interpreted with caution in patients treated with any corticosteroid until further data
are available.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Inflammatory Bowel Diseases |
| Vol/bind | 17 |
| Udgave nummer | 11 |
| Sider (fra-til) | 2340-2349 |
| ISSN | 1078-0998 |
| DOI | |
| Status | Udgivet - nov. 2011 |
FN’s Verdensmål
Dette resultat bidrager til følgende verdensmål
