QuantiFERON-TB Gold In-Tube assay for screening arthritis patients for latent tuberculosis infection before starting anti-tumor necrosis factor treatment

• Published in: PloS one Vol. 10; no. 3; p. e0119260
• Main Authors: Lee, Hyun, Park, Hye Yun, Jeon, Kyeongman, Jeong, Byeong-Ho, Hwang, Ji-Won, Lee, Jaejoon, Cha, Hoon-Suk, Koh, Eun-Mi, Kang, Eun-Suk, Koh, Won-Jung
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.03.2015; Public Library of Science (PLoS)
• Subjects: Adalimumab - pharmacology; Adalimumab - therapeutic use; Adult; Ankylosing spondylitis; Arthritis; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - drug therapy; Assaying; Bacillus Calmette-Guerin vaccine; BCG; Bioassay; Critical care; Diagnosis; Dosage and administration; Drug therapy; Family medical history; Female; Health screening; Humans; Immunization; Immunosuppressive agents; Infections; Infliximab - pharmacology; Infliximab - therapeutic use; Latent Tuberculosis - complications; Latent Tuberculosis - diagnosis; Male; Medical diagnosis; Medicine; Methods; Middle Aged; Necrosis; Patients; Rheumatoid arthritis; Rheumatology; Scars; Screening; Skin tests; Spondylitis; Spondylitis, Ankylosing - complications; Spondylitis, Ankylosing - drug therapy; Studies; TNF inhibitors; Tuberculin; Tuberculosis; Tumor necrosis factor; Tumor necrosis factor inhibitors; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF; Vaccination
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0119260

Patients undergoing anti-tumor necrosis factor (TNF) treatment are at an increased risk of reactivating a latent tuberculosis infection (LTBI). This study evaluated the effectiveness of the QuantiFERON-TB Gold In-Tube (QFT) assay for diagnosing LTBI in arthritis patients undergoing anti-TNF treatment. We enrolled 342 consecutive patients from August 2007 to October 2013: 176 (51.5%) patients with ankylosing spondylitis and 166 (48.5%) with rheumatoid arthritis. Screening tests included tuberculin skin test (TST) and QFT assay. Positive QFT results, regardless of TST results, were considered an indicator for LTBI treatment. Bacillus Calmette-Guérin scars were found in 236 (69.0%) patients. Of 342 patients, TST and QFT were positive in 122 (35.7%) and 103 (30.1%) patients, respectively, and discordant in 101 (29.5%) patients. During a median follow-up duration of 41.7 months, five patients (1.5%) developed TB in a median of 20.8 months after initiation of anti-TNF treatment (428/100,000 person-years). TB did not occur in 62 TST+/QFT+ patients who received LTBI treatment. Of 41 TST-/QFT+ patients who received LTBI treatment, one (2.4%) developed TB 20.5 months after starting anti-TNF treatment (705/100,000 person-years). Of 60 TST+/QFT- patients who did not receive LTBI treatment, two (3.3%) developed TB 20.8 and 22.0 months after starting anti-TNF treatment (871/100,000 person-years). Of 179 TST-/QFT- patients, two (1.1%) developed TB 7.2 and 22.7 months, respectively, after initiating anti-TNF treatment (341/100,000 person-years). TB incidence rate during the follow-up period did not differ among TST-/QFT+, TST+/QFT-, and TST-/QFT- patients (P = 0.661). QFT might be used instead of TST for diagnosing LTBI in patients before starting anti-TNF therapy in countries, such as Korea, where the TB prevalence is intermediate and the BCG vaccination is mandatory at birth. In the absence of a true gold standard test for LTBI, however, there is still a risk of TB development during anti-TNF treatment.