Is tuberculin skin testing reliable during anti–tumor necrosis factor-alfa therapy? A case report and review of the literature

Haddican, Madelaine; Koo, John

doi:10.1016/j.jaad.2009.12.025

Cited by 10 publications

(6 citation statements)

References 11 publications

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“…It was reported that the TST reaction became positive from negative when a patient developed TB during treatment with a TNF inhibitor . It was also reported that the IGRA became positive, while the TST reaction remained negative in some patients who developed TB during treatment with TNF inhibitors . Thus, IGRA might be more sensitive for diagnosis of TB.…”

Section: Discussionmentioning

confidence: 99%

Unaffected reaction level in tuberculin skin test by long‐term therapy with tumor necrosis factor inhibitors for rheumatoid arthritis

et al. 2017

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Aim: The tuberculin skin test (TST) is used to diagnose tuberculosis; however, the influence of tumor necrosis factor (TNF) inhibitors on the test is unclear. This study investigated whether therapy with TNF inhibitors suppresses the TST reaction due to immunosuppression or whether the TST reaction increases due to reactivation of latent Mycobacterium tuberculosis infection.Method: Ninety-one patients with rheumatoid arthritis receiving TNF inhibitors (40 using infliximab and 51 using etanercept) were studied. The TST was performed before starting TNF inhibitors (T1) and more than 1 year after starting them (T2).Results: At T1, the reaction was negative in 45 patients, weakly positive in 21 patients, moderately positive in 18 patients and strongly positive in seven patients, while the numbers at T2 were 44, 20, 16 and 11, respectively. There were no significant differences of the TST reaction between T1 and T2 in all patients (P = 0.657), patients using infliximab (P = 0.462) or patients using etanercept (P = 1.00). No patients with a strongly positive TST reaction at T1 became negative at T2. However, two patients who were negative at T1 became strongly positive at T2. Although they had no signs of M. tuberculosis infection, isoniazid prophylaxis was given. Conclusion:The TST reaction was not suppressed after more than 1 year of therapy with TNF inhibitors. Patients in whom the TST reaction changes from negative to strongly positive may need appropriate prophylaxis.

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Section: Discussionmentioning

confidence: 99%

Unaffected reaction level in tuberculin skin test by long‐term therapy with tumor necrosis factor inhibitors for rheumatoid arthritis

et al. 2017

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“…Another factor that may lead to false-positive results is the Koebner phenomenon (development of psoriatic lesions at the site of trauma), reported after intradermal injection of purified protein derivative (PPD) in psoriatic patients [68]. In contrast, psoriatic patients with negative TST results and positive QFT-G results have been reported [69–71]. The reversion of a positive TST result to a negative result may also occur [72].…”

Section: Discussionmentioning

confidence: 99%

Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review

Solovan

Chiticariu

2013

Infect Dis Ther

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IntroductionThe era of biologic therapies has provided new options for the treatment of chronic plaque psoriasis. However, safety concerns have led to intensive screening and monitoring of patients receiving anti-tumor necrosis factor alpha (anti-TNF-alpha) agents.MethodsThe authors describe the cases of three patients with moderate to severe psoriasis treated with anti-TNF agents, with challenging diagnostic and treatment aspects regarding tuberculosis (TB) infection, a serious adverse event associated with this type of treatment. The cases are discussed in the context of a comprehensive literature review describing the risk of TB associated with the use of TNF inhibitors. A critical review of the clinical trials that have tested the safety of these agents is also presented.ResultsOne patient, who tested negatively for latent TB infection (LTBI) during screening, developed active TB under adalimumab therapy. For two other patients the diagnosis and management of LTBI in relation to anti-TNF therapy represented a challenge. Although clinical trials involving the use of anti-TNF therapy for psoriasis haven’t demonstrated a high TB incidence, active TB is continuously reported in association with this treatment.ConclusionsFindings from clinical practice and the scientific literature indicate that anti-TNF therapies are associated with an increased risk of TB, and close monitoring of patients is needed.

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“…With regards to the suitability of the TST as a diagnostic method for LTBI in psoriasis patients, there are studies which come to different conclusions. The majority state that the sensitivity of the TST may be reduced, given that the psoriasis patient has lower reactivity to the TST both in vivo and in vitro 34–36 . Nevertheless, other authors provide opposing data 29,30 that show greater cutaneous reactivity, which affects the specificity of the test.…”

Section: Discussionmentioning

confidence: 99%

Latent tuberculosis infection and active tuberculosis in patients with psoriasis: a study on the incidence of tuberculosis and the prevalence of latent tuberculosis disease in patients with moderate–severe psoriasis in Spain. BIOBADADERM registry

Sánchez-Moya

García‐Doval²,

Carretero

et al. 2012

Acad Dermatol Venereol

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Is tuberculin skin testing reliable during anti–tumor necrosis factor-alfa therapy? A case report and review of the literature

Cited by 10 publications

References 11 publications

Unaffected reaction level in tuberculin skin test by long‐term therapy with tumor necrosis factor inhibitors for rheumatoid arthritis

Unaffected reaction level in tuberculin skin test by long‐term therapy with tumor necrosis factor inhibitors for rheumatoid arthritis

Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review

Latent tuberculosis infection and active tuberculosis in patients with psoriasis: a study on the incidence of tuberculosis and the prevalence of latent tuberculosis disease in patients with moderate–severe psoriasis in Spain. BIOBADADERM registry

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