Diagnosis of tuberculosis infection by tuberculin skin test and a whole-blood interferon-γ release assay in patients considered for anti–tumor necrosis factor-α therapy

Casas, Susana; Andreu, Ana; Juanola, Xavier; Bordas, X.; Alcaide, Fernando; Moure, Raquel; Anibarro, Luis; Cuchí, Eva; Esteve, María; Ortiz, Vera; Guerra, Maria Rosario; Rodriguez, J.Ontañón; Reina, Dèlia; Salvador, Georgina; Guardiola, Jordi; Surís, Xavier; Pascual, M.; Martí, Carmina; Martínez-Lacasa, Xavier; Cuquet, Jordi; Gonzalez, Lucia; Santín, Miguel

doi:10.1016/j.diagmicrobio.2010.12.020

Cited by 28 publications

(9 citation statements)

References 28 publications

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“…Data concerning the performance of IGRAs in patients with inflammatory disease are limited and sometimes discordant. Recently, it was demonstrated that immunosuppressive treatment affected the TST result more than the IGRA result; to optimize the sensitivity of the diagnosis of tubercular infection, both assays should be used in these subjects [6]. However, considering the greater specificity of IGRAs over TSTs, immunological assays are preferable in areas where BCG coverage is high to avoid unnecessary preventive tubercular therapy.…”

Section: Interferon-gamma Release Assays (Igras)mentioning

confidence: 99%

Cost-effectiveness in the diagnosis of tuberculosis: choices in developing countries

Molicotti

Bua

Zanetti

2014

J Infect Dev Ctries

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Tuberculosis remains one of the major causes of global death from a single infectious agent. This situation is worsened by the HIV/AIDS pandemic because one-third of HIV/AIDS patients are co-infected with Mycobacterium tuberculosis. Failure to control the spread of tuberculosis is largely due to our inability to detect and treat all infectious cases of pulmonary tuberculosis in a timely manner, allowing continued M. tuberculosis transmission within communities. Diagnosis of tuberculosis can be made using indirect and direct methods. The indirect tests, such as interferon-gamma release assays, provide a new diagnostic method for M. tuberculosis infection, but do not discriminate between infection and active disease. The most common direct method for diagnosing TB worldwide is sputum smear microscopy (developed more than 100 years ago), where bacteria are observed in sputum samples examined under a microscope. In countries with more developed laboratory capacities, cases of tuberculosis may also be diagnosed using culture methods (the current gold standard) or, increasingly, using rapid molecular tests. In this review, we discuss the traditional methods for the diagnosis of tuberculosis. We also discuss other inexpensive assays that can be used to detect the presence of M. tuberculosis.

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Section: Interferon-gamma Release Assays (Igras)mentioning

confidence: 99%

Cost-effectiveness in the diagnosis of tuberculosis: choices in developing countries

Molicotti

Bua

Zanetti

2014

J Infect Dev Ctries

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“…Several clinical studies have investigated IGRAs for LTBI diagnosis in patients who are immunosuppressed 7 8. However, all have one significant limitation—the lack of a gold standard to compare test performance against.…”

Section: Introductionmentioning

confidence: 99%

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

Edwards

Gao

Allan

et al. 2017

Thorax

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The impact of immunosuppression on interferon-gamma release assays and novel cytokine biomarkers of TB infection, mycobacteria-specific IL-2, IP-10 and TNF-α responses, was investigated in an ex vivo model. Cytokine responses in standard QuantiFERON-TB Gold in-Tube (QFT-GIT) assays were compared with duplicate assays containing dexamethasone or infliximab. Dexamethasone converted QFT-GIT results from positive to negative in 30% of participants. Antigen-stimulated interferon-γ, IL-2 and TNF-α responses were markedly reduced, but IP-10 responses were preserved. Infliximab caused QFT-GIT result conversion in up to 30% of participants, and substantial reductions in all cytokine responses. Therefore, corticosteroids and anti-TNF-α agents significantly impair IGRA performance. IP-10 may be a more robust TB biomarker than interferon-γ in patients receiving corticosteroids.4

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“…11 13–15 17 18 20–27 A consistent trend was also observed for T-SPOT; though the pooled estimate from the six studies did not reach statistical significance (OR 0.81, 95% CI 0.59 to 1.10) (figure 2). 12 13 16 19–21 Nine studies assessed the effect of immunosuppressive therapy on the indeterminate IGRA results 11–13 15 16 23 25–27. The pooled estimate showed no significant association between immunosuppressive therapy and the rate of indeterminate results in IGRA (OR 1.10, 95% CI 0.75 to 1.61) (see online supplementary figure S2).…”

Section: Resultsmentioning

confidence: 99%

“…First, despite subgroup analyses of different classes of immunosuppressive therapy, the effect of individual therapeutic agents could not be ascertained due to the insufficient raw data. For example, only three studies have provided the raw data for thiopurine or methotrexate18 23 26; and only four studies on steroids mentioned the dosage used (5–10 mg per day respectively12 15 18 26). Further stratified analyses on these individual immunosuppressants cannot be calculated from the original publications.…”

Section: Discussionmentioning

confidence: 99%

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

Wong

Gao

Tsoi

et al. 2015

Thorax

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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.

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Diagnosis of tuberculosis infection by tuberculin skin test and a whole-blood interferon-γ release assay in patients considered for anti–tumor necrosis factor-α therapy

Cited by 28 publications

References 28 publications

Cost-effectiveness in the diagnosis of tuberculosis: choices in developing countries

Cost-effectiveness in the diagnosis of tuberculosis: choices in developing countries

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

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

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