An evaluation of the use of a negative interferon-γ release assay for tuberculosis screening before TNF antagonist therapy
| Autor: | Anton Pozniak, Georgia Woodfield, Michael R. Loebinger, Anob Chakrabarti, Benjamin Passey-Heaton |
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| Rok vydání: | 2014 |
| Předmět: | |
| Zdroj: | European Respiratory Journal. 44:1369-1372 |
| ISSN: | 1399-3003 0903-1936 |
| DOI: | 10.1183/09031936.00125714 |
| Popis: | To the Editor: Tumour necrosis factor (TNF)-α antagonists, such as infliximab, adalimumab and etanercept, are widely used to treat immune-mediated inflammatory diseases. These drugs increase the risk of latent infection with Mycobacterium tuberculosis (LTBI) reactivation [1, 2]. Tuberculosis (TB) preventative chemotherapy significantly reduces this risk (74%); hence, in the UK, patients are screened for LTBI before starting TNF antagonist therapy [3]. The optimum screening strategy remains unclear. Strategies include combinations of clinical risk stratification data, T-cell interferon-γ release assay (IGRA) tests and tuberculin skin tests (TSTs) [2, 4, 5]. These tests have limitations, and have discordant results when compared [6]. The 2005 British Thoracic Society (BTS) guidelines recommend the use of risk stratification tables based on population demographics. These balance the likelihood of LTBI with the risk of therapy-induced hepatotoxicity to guide preventative chemotherapy decisions [7]. Since 2005, IGRAs have become widely available and suggested as a TST alternative [8]. Guidelines have suggested that all IGRA-positive patients (unless secondary to previous, fully treated TB) be given preventative chemotherapy prior to commencing TNF antagonist therapy [9]. This generally consists of 6 months of isoniazid, or 3 months of rifampicin and isoniazid [10]. However, the management of IGRA-negative patients is more complex and this study focuses on this. At our centre, patients with a negative IGRA (enzyme-linked immunospot assay) and normal chest radiography commence TNF antagonist therapy without referral for further LTBI risk assessment. This is based on the improved performance of the IGRA in detecting LTBI compared with the TST, particularly in the context of other immunosuppressive drugs and previous bacille Calmette–Guerin vaccination [2, 11]. This … |
| Databáze: | OpenAIRE |
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