UMMS Affiliation

Department of Medicine; Department of Medicine, Division of Gastroenterology; Department of Medicine, Division of Rheumatology; Department of Medicine, Division of Infectious Diseases and Immunology

Publication Date

2018-02-27

Document Type

Article

Disciplines

Bacterial Infections and Mycoses | Digestive System Diseases | Gastroenterology | Immune System Diseases | Infectious Disease | Musculoskeletal Diseases | Rheumatology | Skin and Connective Tissue Diseases

Abstract

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.

Keywords

IBD flare, corticosteroids, indeterminate QuantiFERON-TB Gold, inflammatory bowel disease, latent TB infection, rheumatoid arthritis

Rights and Permissions

© 2018 Hakimian et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

DOI of Published Version

10.2147/BTT.S150958

Source

Biologics. 2018 Feb 27;12:61-67. doi: 10.2147/BTT.S150958. eCollection 2018. Link to article on publisher's site

Journal/Book/Conference Title

Biologics : targets and therapy

Related Resources

Link to Article in PubMed

PubMed ID

29520131

Creative Commons License

Creative Commons Attribution-Noncommercial 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License

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