Prevention of Anti-Tumor Necrosis Factor-Associated Tuberculosis: A 10-Year Longitudinal Cohort Study
| Autor: | Miguel Santin, Susana Casas, Concepcion Martinez, X. Juanola, Laura Muñoz, Xavier Bordas |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Microbiology (medical) medicine.medical_specialty Tuberculosis Tuberculin Risk Assessment Cohort Studies Latent Tuberculosis Internal medicine medicine Humans Anti tumor necrosis factor Longitudinal Studies Longitudinal cohort Latent tuberculosis Tuberculin Test Tumor Necrosis Factor-alpha business.industry Incidence (epidemiology) Clinical course Middle Aged bacterial infections and mycoses medicine.disease Anti-Tumor Necrosis Factor Therapy Infectious Diseases Immunology Female business |
| Zdroj: | Clinical Infectious Diseases. 60:349-356 |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/ciu796 |
| Popis: | Background. The extent to which anti–tumor necrosis factor (TNF)–associated tuberculosis can be preventedis unclear, and there is no established guidance on the optimal screening strategy for latent tuberculosis (LTBI) inpatients about to start anti-TNF therapy. We aimed to determine the effectiveness of a comprehensive program forthe prevention of anti-TNF–associated tuberculosis, and to evaluate 3 LTBI screening strategies and the need forretesting patients with negative results at baseline.Methods. In total, 726 patients were screened prior to anti-TNF therapy using 1 of 3 diagnostic strategies over 3consecutive periods: first, a 2-step tuberculin skin test (TST); second, a 2-step TST plus QuantiFERON-TB Gold In-Tube test (QFT-GIT) (2-step TST/QFT); and third, a single-step TST plus QFT-GIT (TST/QFT). Infected patientswere offered preventive therapy. We assessed differences in the incidence of tuberculosis between anti-TNF exposedand nonexposed patients, and between the 3 study periods.Results. Tuberculosis developed during the first year in 2.85 per 1000 exposed patient-years (3/1052 patient-years) and 1.77 per 1000 nonexposed patient-years (1/566 patient-years). No cases occurred beyond the first yearof treatment. LTBI diagnoses decreased with the single-step TST/QFT (26.5%) compared with the 2-step TST(42.5%; P |
| Databáze: | OpenAIRE |
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