P-044 Outcomes of Tuberculin Skin Test in Routine Screening for Latent Tuberculosis Infection in Patients with Inflammatory Bowel Diseases. (March 2016)

• Record Type: Journal Article
• Authors: Taxonera, Carlos; Ponferrada, Angel; Gisbert, Javier Pérez; Riestra, Sabino; Saro, Cristina; Cabriada, Jose Luis; Barreiro-de acosta, Manuel; Barrio, Jesús; Marín-Jiménez, Ignacio; Hinojosa, Joaquin; Argüelles-Arias, Federico; Van Domselaar, Manuel; Rivero, Montserrat; Martínez-Montiel, Pilar; Carpio, Daniel; Martín, Daniel; Verdejo, Cristina; Mendoza, Juan Luis; Bermejo, Fernando
• Is Part Of: Inflammatory bowel diseases. Volume 22(2016:Mar.)Supplement 1
• Publication Date: 2016-03
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/01.MIB.0000480090.87597.55
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: Screening for latent tuberculosis infection (LTBI) before starting therapy with anti tumor necrosis factor (anti-TNF) antibodies has decreased the risk of active tuberculosis. Corticosteroids (CS) or immunosuppressive (IS) therapy negatively affected the performance of the Tuberculin skin test (TST). The aim of this study was to determine the impact CS and IM therapy on the likelihood of detecting LTBI using a 2-step TST. We also attempted to evaluate whether testing at an early stage increases the sensitivity of the TST. Methods: This prospective multicenter case-control study included 249 consecutive patients selected for anti-TNF therapy and 338 controls non-candidates for anti-TNF therapy. LTBI risk factors were recorded and patients underwent chest x-ray and 2-step TST. TST was considered positive if induration was ≥5 mm in the first or second (booster) test. Factors associated with TST results were analyzed by logistic regression. Results: Of the 587 patients included, 102 (17%) had a positive TST (26/102 [25.5%] in the second test). At the time of the TST, 141 (24%) patients were receiving CS therapy, 280 (48%) IS therapy and 66 (11%) CS + IS therapy. In the univariate analysis, positive TST was associated with age, Bacille Calmette-Guerin vaccination and mesalazine therapy. Negative TST was associated with CS therapy, IS therapy, CS + IS therapy, Crohn's disease versus ulcerative colitis, anti-TNF group versus control group and elevated CRP. In the multivariate analysis, positive TST was only associated with age while negative TST was associated with CS therapy (OR 0.42; 95% CI 0.2–0.77; P = 0.004), IS therapy (OR 0.33; 95% CI 0.20–0.54; P < 0.001) and CS + IS therapy (OR 0.28; 95% CI 0.10–0.79; P = 0.011). Positive TST was inversely correlated with higher doses (mg) of CS at the time of TST. More anti-TNF group patients were receiving CS therapy, IS therapy or CS + IS therapy. As a result, the likelihood of having a positive TST was lower in patients selected for anti-TNF therapy (25/249 [10%]) than in controls in which the test was performed earlier (76/338 [22.5%]; P = 0.001). Conclusions: We found a pronounced negative effect of CS and IM therapy on TST performance in IBD patients selected for anti-TNF therapy. Therefore, to increase the sensitivity of TST patients should be screened for LTBI earlier and better before starting CS or IS therapy. The second TST is useful because it increases detection sensitivity by 25%.