Department of Medicine; Department of Medicine, Division of Gastroenterology; Department of Medicine, Division of Rheumatology; Department of Medicine, Division of Infectious Diseases and Immunology
Bacterial Infections and Mycoses | Digestive System Diseases | Gastroenterology | Immune System Diseases | Infectious Disease | Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases
Background: Tumor necrosis factor alpha (TNFalpha) is a key cytokine in both the pathogenesis of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) and the host defense against tuberculosis (TB). Consequently, anti-TNFalpha medications result in an increased risk of latent TB infection (LTBI) reactivation. Here, we sought to evaluate the factors affecting the results of QuantiFERON-TB Gold In-Tube (QFT-GIT) assay as a screening tool for LTBI.
Methods: We conducted an observational, retrospective study in patients with IBD and RA who underwent LTBI screening using QFT-GIT at UMass Memorial Medical Center between 2008 and 2016 prior to initiation of anti-TNF medications.
Results: We included 107 and 89 patients with IBD and RA, respectively. We found that a higher proportion of IBD patients had indeterminate QFT-GIT result compared to RA patients. Furthermore, we found that the majority of patients with indeterminate results were tested during an acute flare of IBD (88%) and while taking corticosteroids. Of all patients receiving > /=20 mg equivalent prednisone dose (n=32), 63% resulted in indeterminate QFT-GIT, compared to only 6% indeterminate testing in patients receiving < 20 mg of equivalent prednisone dose (n=164, P < 0.001). There was no correlation between indeterminate results and age, gender, disease duration, or distribution, or smoking status within each population.
Conclusion: We observed that high-dose corticosteroids may affect QFT-GIT outcomes leading to a high proportion of indeterminate results. We propose that IBD patients should be tested prior to initiation of corticosteroids to avoid equivocal results and prevent potential delays in initiation of anti-TNF medications.
IBD flare, corticosteroids, indeterminate QuantiFERON-TB Gold, inflammatory bowel disease, latent TB infection, rheumatoid arthritis
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DOI of Published Version
Biologics. 2018 Feb 27;12:61-67. doi: 10.2147/BTT.S150958. eCollection 2018. Link to article on publisher's site
Biologics : targets and therapy
Hakimian S, Popov Y, Rupawala A, Salomon-Escoto KI, Hatch S, Pellish R. (2018). The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation. Open Access Publications by UMMS Authors. https://doi.org/10.2147/BTT.S150958. Retrieved from https://escholarship.umassmed.edu/oapubs/3354
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This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License
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