Early Tuberculin Skin Test for the Diagnosis of Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease. (17th February 2017)

• Record Type: Journal Article
• Authors: Taxonera, Carlos; Ponferrada, Ángel; Bermejo, Fernando; Riestra, Sabino; Saro, Cristina; Martín-Arranz, María Dolores; Cabriada, José Luis; Barreiro-de Acosta, Manuel; de Castro, María Luisa; López-Serrano, Pilar; Barrio, Jesús; Suarez, Cristina; Iglesias, Eva; Argüelles-Arias, Federico; Ferrer, Isabel; Marín-Jiménez, Ignacio; Hernández-Camba, Alejandro; Bastida, Guillermo; Van Domselaar, Manuel; Martínez-Montiel, Pilar; Olivares, David; Alba, Cristina; Gisbert, Javier P.
• Is Part Of: Journal of Crohn's and colitis. Volume 11:Number 7(2017:Jul.)
• Page Start: 792
• Page End: 800
• Publication Date: 2017-02-17
• Subjects: Tuberculosis -- tuberculin skin test -- anti-TNF -- ulcerative colitis -- Crohn′s disease -- steroid -- immunosuppressant -- inflammatory bowel disease; Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx022
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background and Aim: Sensitivity of tuberculin skin test [TST] during screening for latent tuberculosis infection [LTBI] is affected by steroid and/or immunosuppressant therapy. The aim of this study was to compare performance of the two-step TST in inflammatory bowel disease patients immediately before anti-tumour necrosis factor [TNF] therapy as part of routine screening for LTBI vs control patients when the TST was carried out at an early stage. Methods: In this multicentre prospective controlled study, we evaluated the performance of two-step TST with 5-mm threshold. Factors associated with TST results were determined by logistic regression. Results: We evaluated 243 candidates for anti-TNF therapy and 337 control patients. Overall, 105 patients [18.1%] had an induration ≥ 5 mm in the first TST or in TST retest. LTBI was diagnosed in 25% of patients by TST retest. Twenty-eight [11.5%] anti-TNF group patients vs 77 [22.8%] control patients had a positive TST (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.28–0.70; P < 0.001]. In multivariate analysis, positive TST was associated with higher age [OR 2.63, 95% CI 1.21–5.72; P < 0.001] and 5-aminosalicylate therapy [OR 1.86, 95% CI 1.14–3.05; P = 0.013]. Negative TST was associated with steroid therapy [OR 0.36, 95% CI 0.16–0.83; P = 0.016], immunosuppressant therapy [OR 0.36, 95% CI 0.21–0.62; P < 0.001], or steroids + immunosuppressant therapy [OR 0.20, 95% CI 0.07–0.59; P = 0.004]. Conclusions: The sensitivity of routine TST performed just before starting anti-TNF therapy is low. TST performed at an early stage enables screening in the absence of immunosuppressive treatment and thus maximises the diagnostic yield of TST for detecting LTBI.