Serial Tuberculin Skin Tests Improve the Detection of Latent Tuberculosis Infection in Patients With Inflammatory Bowel Disease

Autor: Taxonera, C, Ponferrada, A, Riestra, S, Bermejo, F, Saro, C, Martin-Arranz, MD, Cabriada, JL, Barreiro-de Acosta, M, de Castro, ML, Lopez-Serrano, P, Barrio, J, Suarez, C, Iglesias, E, Arguelles-Arias, F, Ferrer, I, Marin-Jimenez, I, Hernandez-Camba, A, Bastida, G, Van Domselaar, M, Martinez-Montiel, P, Olivares, D, Rivero, M, Fernandez-Salazar, L, Nantes, O, Merino, O, Alba, C, Gisberty, JP, Martin-Rodriguez, MD, Botella, B, Carpio, D, Ceballos, D, Verdejo, C, Morales, I, Legido, J, Penate, M, Chaparro, M, Algaba, A, de Francisco, R, CONVERT Study Grp GETECCU
Rok vydání: 2018
Předmět:
Zdroj: Journal of Crohn's & colitis
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
instname
ISSN: 1873-9946
Popis: Aim: To assess the likelihood of detecting latent tuberculosis infection [LTBI] by the positive conversion of a serial tuberculin skin test [TST] at 1 year in inflammatory bowel disease [IBD] patients with negative baseline two-step TST. Methods: In this multicentre prospective cohort study, we evaluated rate and predictors of conversion of TST at 1 year in patients with negative baseline TST. We also evaluated management of patients who had a positive TST at baseline or a conversion at 1 year. In all patients we assessed TB cases occurring during follow-up. Results: Of the 192 IBD patients receiving anti-tumour necrosis factor [TNF] and 220 IBD controls not receiving anti-TNF, 35 [8.5%, 95% CI 5.7-11.3] had positive conversion (median TST induration 13 mm, interquartile range [IQR] 9-16). Ten anti-TNF cohort patients [5.2%, 95% CI 2.5-9.5] versus 25 controls [11.4%, 95% CI 7.5-16.3] had TST conversion [p = 0.029]. In multivariate analysis, conversion was associated with smoking habit (odds ratio [OR] 2.19, 95% CI 1.08-3.97; p = 0.028). Anti-TNF-treated patients had a lower conversion rate [OR 0.41, 95% CI 0.20-0.83; p = 0.013]. The likelihood of conversion correlates with fewer immunosuppressive therapies between baseline TST and TST at 1 year [p = 0.042]. One case of active TB [isoniazid-resistant strain] occurred in a patient with positive baseline TST receiving anti-TNF [0.05 events/100 patient-years]. Conclusions: Serial TST at 1 year can detect LTBI in IBD patients receiving anti-TNF therapy with negative baseline TST. Serial TST seems to be advisable to reduce the risk of TB cases associated with inability to detect LTBI in pre-treatment screening.
Databáze: OpenAIRE
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