Serial Tuberculosis Screening in Inflammatory Bowel Disease Patients Receiving Anti-TNFα Therapy

Abreu, Cândida; Afonso, Joana; Dias, Cláudia Camila; Ruas, Rogério; Sarmento, António; Magro, Fernando

doi:10.1093/ecco-jcc/jjx080

Cited by 18 publications

(29 citation statements)

References 25 publications

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“…The development of active TB in patients under TNF-α antagonists might be main outcome to evaluate the efficacy of assay. However, only seventeen of our included studies [25,27,33,36] reported the follow-up data of patient and 74 active cases were reported [36]. The concordance between IGRAs and TST was poor to moderate which demonstrates the differences between these two tests.…”

Section: Studies Comparing Tst and Qft-git And Evaluating The Clinicamentioning

confidence: 87%

“…All these studies used both TST and QuantiFERON tests (10 QFT-GT and 17 QFT-GIT) before TNF-α inhibitor therapy. The ten of these papers evaluated both QFT and T-SPOT.TB or T-SPOT.TB [36][37][38][39][40][41][42][43][44][45].…”

Section: Study Selectionmentioning

confidence: 99%

“…Positive QFT-GIT test converted to negative in 4% of patients, while QFT negative was not changed[34]. Characteristic of selected studiesAbreu et al (2017) screened LTBI by TST and two different IGRAs assays [QFT-GIT and T-SPOT.TB] in IBD patients under anti-TNF-α therapy for 26 months. LTBI were detecting in 16 patients: TST positive in 12 patients; T-SPOT positive in 7 patients, QFT-GIT positive in 2 patients.…”

mentioning

confidence: 99%

“…LTBI treated for 15 patients. TST have higher sensitivity than the IGRAs according to interferon ϒ release[36] Kim ES et al (2015). investigated LTBI in IBD patients under TNF-α inhibitors therapy using TST, QFT-GIT and TSPOT prior to treatment.…”

mentioning

confidence: 99%

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An updated systematic review on the applied TST and IGRA Test for diagnosing LTBI in patients treated with TNF-α inhibitor drugs

2019

Biointerface Res Appl Chem

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Present systematic review was designed to compare the efficacy of interferon-γ release assays (IGRAs) and tuberculin skin test (TST) for diagnosing latent tuberculosis infection (LTBI) in patients subjected to the anti-TNF-α therapy. The MEDLINE (Ovid), PubMed, Embase, Scopus, Cochrane library, and Web of Science ISI databases were searched for selecting studies to compare the efficiency of IGRAs [QuantiFERONTB Gold (QFT-GT), QuantiFERON-TB Gold In-Tube (QFT-GIT)and T-SPOT.TB] and TST in patients under the anti-TNF-α therapy. After evaluating all studies, we systemically reviewed the results of 37 studies with a total sample size of 8584 patients. The agreement between IGRASs and TST was poor to moderate, however, the anti-TNF-α therapy mostly decreased the percentage of this agreement. BCG vaccination could cause false results of TST assay. The developed active TB in patients with IGRAs positive results during follow-up showed lower than TST positive patients. In conclusion, in the treated patients with anti-TNF-α with previous BCG vaccination, IGRAs might be the better assay to diagnosis LTBI by reducing the false results rate in comparison with the TST. However, more investigations should be done to compare the advantage of IGRAs with conventional test in the treated patients with TNF-α antagonists.

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Section: Studies Comparing Tst and Qft-git And Evaluating The Clinicamentioning

confidence: 87%

Section: Study Selectionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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An updated systematic review on the applied TST and IGRA Test for diagnosing LTBI in patients treated with TNF-α inhibitor drugs

2019

Biointerface Res Appl Chem

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“…There is a lack of information and some controversy regarding the most effective latent TB rescreening method during anti-TNF therapy. In a recent Portuguese study about the utility and sensitivity of TB screening during anti-TNF therapy, TST appeared to be more sensitive than IGRA in the diagnosis of latent infection [21]. Additionally active TB must be ruled out in patients with persistent fever or clinical deterioration [7].…”

Section: Discussionmentioning

confidence: 99%

Miliary Tuberculosis in a Crohn’s Disease Patient: The Risk beyond the Screening

Carvalho

Túlio

Rodrigues

et al. 2018

GE Port J Gastroenterol

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Tumor necrosis factor alpha (TNFα) antagonist is recognized as an effective treatment to achieve clinical remission and healing mucosal in patients with moderate to severe active Crohn’s disease. Considering that it plays a central role in immune-mediated modulation, there are some obvious concerns about its long-term safety. There is evidence that it may increase the risk of opportunistic infections such as tuberculosis, particularly reactivation of previous latent infection. Due to the global high incidence of tuberculosis and its frequent severity in immunocompromised patients, the exclusion of latent infection is currently part of the screening prior to anti-TNFα therapy. Only a few cases of life-threatening disseminated tuberculosis have been reported in immunocompromised patients probably related to widespread use of higher-accuracy screening tests, such as interferon-γ release assays. However, despite negative screening, the risk of active tuberculosis infection remains during treatment. In that instance, tuberculosis infection becomes considerably more difficult to diagnose due to its altered pattern presentation (extrapulmonary and disseminated infection) and is harder to treat because of the high rate of resistance and its associated relevant morbidity and mortality. We report an enigmatic case of a miliary tuberculosis despite negative latent infection screening, using interferon-γ release assays, in a Crohn’s disease patient undergoing treatment with infliximab and azathioprine, focusing on the screening and diagnostic and therapeutic challenge. This case enhances the awareness of anti-TNFα therapy management and the need for strategies to diagnose and treat tuberculosis in this context.

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Infliximab

2017

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Serial Tuberculosis Screening in Inflammatory Bowel Disease Patients Receiving Anti-TNFα Therapy

Cited by 18 publications

References 25 publications

An updated systematic review on the applied TST and IGRA Test for diagnosing LTBI in patients treated with TNF-α inhibitor drugs

An updated systematic review on the applied TST and IGRA Test for diagnosing LTBI in patients treated with TNF-α inhibitor drugs

Miliary Tuberculosis in a Crohn’s Disease Patient: The Risk beyond the Screening

Infliximab

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