High rates of tuberculin skin test positivity due to methotrexate therapy: False positive results?

Arias-Guillén, Miguel; Menéndez, Marta M. Sánchez; Alpéri, Mercedes; Riestra, Sabino; Budiño, María Teresa González; García‐Clemente, Marta; Martínez-González, Susana; Enríquez, Ana Isabel; Alonso-Arias, Rebeca; Palacios, Juan José; Santibáñez, Miguel; Coto‐Segura, Pablo; Camblor, Pablo Martínez; García-Alfonso, Lucía; Morante, Isla; Escalante, Patricio

doi:10.1016/j.semarthrit.2018.03.018

Cited by 19 publications

(17 citation statements)

References 24 publications

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“…Saliu et al 24 found that infliximab and adalimumab suppressed antigen‐induced IFN‐γ production by 70% and 64%, respectively. However, another study reported that methotrexate use was associated with a statistically significant twofold increase in the risk of a positive TST 25 . Centers for Diseases Control and Prevention (CDC) recommends screening all patients with TST or IGRA before initiation of anti‐TNF treatment and does not routinely recommend the combination of TST and IGRA for each patient 26 .…”

Section: Discussionmentioning

confidence: 99%

Usefulness of screening tests for diagnosis of latent tuberculosis infection in children

Böncüoğlu¹,

Kıymet²,

Şahinkaya³

et al. 2021

Pediatric Pulmonology

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Background The aim of this study is to provide a basis for the development of appropriate screening strategies and evaluate the indications of the interferon‐gamma release assay (IGRA) in Bacillus Calmette–Guérin (BCG)‐vaccinated children. Methods Children who were examined with both IGRA (QuantiFERON®‐TB Gold Plus) and tuberculin skin test (TST) for tuberculosis infection were included in the study. Underlying medical conditions of the patients were recorded. Cohen's κ was run to determine if there was an agreement between TST and IGRA. Results A total of 220 patients with a mean age of 11.05 ± 4.43 years (2.5–18 years) were analyzed. Ninety‐nine patients were immunocompromised and 121 patients were immunocompetent. TSTs and IGRA showed none to the slight agreement in both of the immunocompromised and immunocompetent patients. In the immunocompromised group, 43/99 (43.4%) and the immunocompetent group 35/121 (28.9%) of the tests did not show any correlation. Conclusion In a high‐risk setting where the BCG vaccine is mandatory, it may be beneficial to use IGRA primarily in immunocompetent patients. In immunocompromised patients, the use of both the TST and IGRA could increase the efficacy of screening for latent tuberculosis infection.

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Section: Discussionmentioning

confidence: 99%

Usefulness of screening tests for diagnosis of latent tuberculosis infection in children

Böncüoğlu¹,

Kıymet²,

Şahinkaya³

et al. 2021

Pediatric Pulmonology

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“…The missing data for TNF-α were probably responsible for the lack of a significant increase in their results. Tavast et al [11] found an association between immunosuppression and positive TST results, and one multicentric study found high rates of TST positivity during MTX therapy [35]. Experimental studies observed that mononuclear cell death increases IFN-γ and TNF-α due to the cytotoxic effect of MTX [36][37][38].…”

Section: Discussionmentioning

confidence: 99%

TST conversions and systemic interferon-gamma increase after methotrexate introduction in psoriasis patients

et al. 2020

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Background Tuberculosis screening in psoriasis patients is complex due to the immunological alterations associated with psoriasis, the presence of comorbidities, and the effect of immunosuppressive treatment. However, it is not established whether the results of screening tests are affected by these factors in psoriasis patients. Objectives To determine whether there is a change in the results of the tuberculin skin test (TST) or the interferon-gamma release assay (IGRA) in psoriasis patients living in tuberculosis (TB)-endemic area after 12 weeks of methotrexate (MTX) treatment and to investigate the association of the test results with clinical and inflammatory markers. Methods Forty-five patients were selected for a prospective single-arm self-controlled study and followed for at least 18 months. The TST, IGRA, Psoriasis Area and Severity Index (PASI), and inflammatory factors (erythrocyte sedimentation rate (ESR), C-reactive protein, interferon-gamma (IFN-γ), and tumor necrosis factor-alpha levels), were determined before and after 12 weeks of oral 15 mg per week MTX administration and compared. The associations between the IGRA and TST results were verified before and after treatment according to inflammatory factors and clinical characteristics (age, blood glucose, weight, body mass index, disease duration, and PASI). Results We collected data on 25 patients who completed the full course of therapy and the follow-up. None of the patients developed TB. TST positivity was significantly elevated at week 12 (25% baseline vs 44% at week 12, P < 0.037). Three IGRAs followed the TST conversions. There was no difference between TST and IGRA pre- or posttreatment. Serum IFN-γ increased significantly in week 12 (15.95 pg/ml baseline vs 18.82 pg/ml at week 12, P < 0.005) and tended to be higher among TST-positive patients (P = 0.072). The baseline IGRA was associated with a higher ESR (P = 0.038). None of the test results were associated with clinical characteristics. Conclusions In addition to the classic booster effect, TST conversions in patients using MTX can occur due to an increase in IFN-γ. However, it is not possible to exclude true TST conversions. Therefore, other diagnostic methods, like IGRA or chest tomography, should be used when the TST has intermediate results.

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“…Ein Screening vor der Behandlung mit MTX wird in der Fachinformation empfohlen. Die Sensitivität von IGRA und TST kann durch konventionelle immunsuppressive Behandlungen beeinflusst werden, so dass ein anfängliches IGRA vorteilhaft sein kann, wenn ein späterer Wechsel, insbesondere von MTX zu anderen Medikamentenklassen, wahrscheinlich erscheint [111].…”

Section: Risiko Der Tb-reaktivierung Bei Unterschiedlichen Behandlungenunclassified

Deutsche S3‐Leitlinie zur Therapie der Psoriasis vulgaris, adaptiert von EuroGuiDerm – Teil 2: Therapiemonitoring, besondere klinische Situationen und Komorbidität

Nast

Altenburg

Augustin

et al. 2021

J Deutsche Derma Gesell

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High rates of tuberculin skin test positivity due to methotrexate therapy: False positive results?

Cited by 19 publications

References 24 publications

Usefulness of screening tests for diagnosis of latent tuberculosis infection in children

Usefulness of screening tests for diagnosis of latent tuberculosis infection in children

TST conversions and systemic interferon-gamma increase after methotrexate introduction in psoriasis patients

Deutsche S3‐Leitlinie zur Therapie der Psoriasis vulgaris, adaptiert von EuroGuiDerm – Teil 2: Therapiemonitoring, besondere klinische Situationen und Komorbidität

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