Comparison of interferon {gamma} release assays and conventional screening tests before tumour necrosis factor {alpha} blockade in patients with inflammatory arthritis.
Martin, J Walsh, C Gibbs, A McDonnell, T Fearon, U Keane, J Codd, M B Dodd, J Veale, D Fitzgerald, O
Martin, J
Walsh, C
Gibbs, A
McDonnell, T
Fearon, U
Keane, J
Codd, M B
Dodd, J
Veale, D
Fitzgerald, O
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Other Contributors
Date
2012-02-01T10:28:28Z
Date Submitted
Keywords
Other Subjects
Subject Mesh
Adolescent
Adult
Aged
Aged, 80 and over
Antirheumatic Agents/*therapeutic use
Arthritis/complications/drug therapy/*immunology
Arthritis, Rheumatoid/complications/drug therapy/immunology
Humans
Interferon-gamma/*biosynthesis
Latent Tuberculosis/complications/*diagnosis/immunology
Mass Screening/methods
Middle Aged
Tuberculin Test
Tumor Necrosis Factor-alpha/*antagonists & inhibitors
Young Adult
Adult
Aged
Aged, 80 and over
Antirheumatic Agents/*therapeutic use
Arthritis/complications/drug therapy/*immunology
Arthritis, Rheumatoid/complications/drug therapy/immunology
Humans
Interferon-gamma/*biosynthesis
Latent Tuberculosis/complications/*diagnosis/immunology
Mass Screening/methods
Middle Aged
Tuberculin Test
Tumor Necrosis Factor-alpha/*antagonists & inhibitors
Young Adult
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
Abstract
OBJECTIVE: To compare the performance of two interferon gamma release assays (IGRAs) and conventional screening tests in patients with inflammatory arthritis undergoing screening for latent tuberculosis infection (LTBI) before treatment with anti-tumour necrosis factor alpha (anti-TNFalpha) compounds. METHODS: Successive patients were subjected to conventional LTBI screening, including a tuberculin skin test (TST). The T-SPOT.TB test was performed on all patients and the QuantiFERON-TB Gold test was performed on a large subset. The results of the IGRAs were compared with the results of conventional screening tests. RESULTS: A total 150 patients were evaluated. The majority (57.9%) had rheumatoid arthritis. Previous vaccination with Bacille Calmette-Guerin was confirmed in 82% of patients. No patient had received prior anti-TB treatment. A total of 57 patients (38.0%) had at least one positive conventional risk factor. In contrast, an unequivocally positive T-SPOT.TB test was seen in only 14/143 (9.8%). There was 98.2% agreement between the two IGRAs. Statistically significant associations were found between each of the IGRAs and both TST and risk history, but not chest x-ray (CXR). A positive IGRA result was significantly associated with increased age. TB was not reactivated in any patient during the follow-up period. Interpretation: This study suggests that IGRAs may be useful when screening for LTBI before anti-TNFalpha therapy in patients with immune-mediated inflammatory diseases. The observations reported here also highlight the inadequate performance of CXR as a marker of LTBI.
Language
eng
ISSN
1468-2060 (Electronic)
0003-4967 (Linking)
0003-4967 (Linking)
eISSN
ISBN
DOI
10.1136/ard.2008.101857
PMID
19176545