Numbers needed to treat to prevent tuberculosis

Sester, Martina; Crevel, Reinout van; Leth, Frank van; Lange, Christoph

doi:10.1183/13993003.01047-2015

Cited by 32 publications

(18 citation statements)

References 10 publications

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“…Although recent Mtb exposure and TST-or IGRA-confirmed conversion are associated with higher risk of TB progression (6), the positive predictive values of these tests are low (1.5% and 2.7%, respectively) (7), falling short of current World Health Organization-supported guidelines for incipient TB (8). Thus, the number of TST1 or IGRA1 individuals requiring treatment to prevent progression to a single incident case of TB is prohibitively high (9).…”

Section: Tuberculosis (Tb) Caused By Infection Withmentioning

confidence: 99%

Four-Gene Pan-African Blood Signature Predicts Progression to Tuberculosis

Suliman

Thompson

Sutherland

et al. 2018

Am J Respir Crit Care Med

220

226

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Rationale: Contacts of patients with tuberculosis (TB) constitute an important target population for preventive measures because they are at high risk of infection with Mycobacterium tuberculosis and progression to disease.Objectives: We investigated biosignatures with predictive ability for incident TB.Methods: In a case-control study nested within the Grand Challenges 6-74 longitudinal HIV-negative African cohort of exposed household contacts, we employed RNA sequencing, PCR, and the pair ratio algorithm in a training/test set approach. Overall, 79 progressors who developed TB between 3 and 24 months after diagnosis of index case and 328 matched nonprogressors who remained healthy during 24 months of follow-up were investigated. Measurements and Main Results:A four-transcript signature derived from samples in a South African and Gambian training set predicted progression up to two years before onset of disease in blinded test set samples from South Africa, the Gambia, and Ethiopia with little population-associated variability, and it was also validated in an external cohort of South African adolescents with latent M. tuberculosis infection. By contrast, published diagnostic or prognostic TB signatures were predicted in samples from some but not all three countries, indicating site-specific variability. Post hoc meta-analysis identified a single gene pair, C1QC/TRAV27 (complement C1q C-chain / T-cell receptor-a variable gene 27) that would consistently predict TB progression in household contacts from multiple African sites but not in infected adolescents without known recent exposure events.Conclusions: Collectively, we developed a simple whole blood-based PCR test to predict TB in recently exposed household contacts from diverse African populations. This test has potential for implementation in national TB contact investigation programs.

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Section: Tuberculosis (Tb) Caused By Infection Withmentioning

confidence: 99%

Four-Gene Pan-African Blood Signature Predicts Progression to Tuberculosis

Suliman

Thompson

Sutherland

et al. 2018

Am J Respir Crit Care Med

220

226

View full text Add to dashboard Cite

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“…dikation bisher nicht zugelassen) und INH in erhöhter Dosierung über drei Monate zeigten in Metaanalysen randomisierter Studien im Vergleich zur mindestens sechsmonatigen täglichen Gabe von INH keine Unterlegenheit hinsichtlich der Wirksamkeit bei ähnlicher oder geringerer Häufigkeit und Schwere einer Hepatotoxizität[127,128].Wirksamkeit der präventiven TherapieZur Beurteilung der Wirksamkeit der präventiven Therapie mit INH liegen in ausreichender Zahl kontrollierte Studien vor, die sowohl für HIV-negative[129] als auch für HIV-positive Personen[130] jeweils in einer Cochrane-Metaanalyse analysiert wurden. Die Anzahl der chemopräventiv zu behandelnden Personen, um eine Tuberkulose zu verhindern (NNT, number needed to treat), liegt bei Immunkompetenten zwischen 30 und 89 und bei Immungeschwächten zwischen 14 und 80[131]. Möglicherweise sind Therapieschemata basierend auf Rifamycin-Derivaten sogar effektiver als die INH-Monotherapie für die Behandlung der LTBI[126,128].…”

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S2k-Leitlinie: Tuberkulose im Erwachsenenalter

et al. 2017

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Since 2015 a significant increase in tuberculosis cases is notified in Germany, mostly due to rising numbers of migrants connected to the recent refugee crisis. Because of the low incidence in previous years, knowledge on tuberculosis is more and more limited to specialized centers. However, lung specialist and healthcare workers of other fields have contact to an increasing number of tuberculosis patients. In this situation, guidance for the management of standard therapy and especially for uncommon situations will be essential. This new guideline on tuberculosis in adults gives recommendations on diagnosis, treatment, prevention and prophylaxis. It provides a comprehensive overview over the current knowledge, adapted to the specific situation in Germany. The German Central Committee against Tuberculosis (DZK e. V.) realized this guideline on behalf of the German Respiratory Society (DGP). A specific guideline for tuberculosis in the pediatrics field will be published separately. Compared to the former recommendations of the year 2012, microbiological diagnostics and therapeutic drug management were given own sections. Chapters about the treatment of drug-resistant tuberculosis, tuberculosis in people living with HIV and pharmacological management were extended. This revised guideline aims to be a useful tool for practitioners and other health care providers to deal with the recent challenges of tuberculosis treatment in Germany.

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“…Though the utility of repeated testing is limited in areas of low disease prevalence like ours, development of active TB can be catastrophic and thus follow‐up screening is recommended as per ACR and CDC guidelines. The number of individuals with positive immunodiagnostic results needed to treat to prevent a case of TB among immunocompromised patients vary from 50 to 80 per one study . The study subjects included rheumatoid arthritis patients, but it did not mention if they received biologics or not.…”

Section: Discussionmentioning

confidence: 99%

Conversion of Tuberculosis Screening Tests During Biologic Therapy Among Veteran Patient Population With Rheumatic Disease

Pattanaik

Gupta

Islam

et al. 2019

ACR Open Rheumatology

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ObjectiveThe optimal strategy to detect the development of tuberculosis (TB) in subjects receiving biologic agents is not clear. The recommendations vary because there is wide variation in the reported rate of seroconversion in various parts of the world. There is a scarcity of long‐term studies regarding seroconversion of TB in the United States among these patients.MethodsThis is a retrospective study among veteran populations with rheumatic diseases who received various biologic agents between 2003 and 2014. Subjects who had repeated TB screening tests and adequate follow‐up periods were considered for the study.ResultsOut of 298 subjects who received biologic agents, 123 were considered for the study. After the initial negative screening test by tuberculin skin test (TST), patients were screened on an average of 1.2 years for 4.3 to 12 years. A total of 420 tests were performed, which were combination of TST and QuantiFERON‐TB gold in‐Tube assay. Only 1 out of 123 subjects (0.8%) seroconverted to latent TB and was treated with isoniazid for 9 months.ConclusionOur results are in line with a few other studies reported from the United States. We conclude that in areas with low prevalence of TB the seroconversion rate is extremely low and annual testing is unnecessary in low‐risk patient populations.

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Numbers needed to treat to prevent tuberculosis

Cited by 32 publications

References 10 publications

Four-Gene Pan-African Blood Signature Predicts Progression to Tuberculosis

Four-Gene Pan-African Blood Signature Predicts Progression to Tuberculosis

S2k-Leitlinie: Tuberkulose im Erwachsenenalter

Conversion of Tuberculosis Screening Tests During Biologic Therapy Among Veteran Patient Population With Rheumatic Disease

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