Retesting for latent tuberculosis in patients with inflammatory bowel disease treated with TNF-α inhibitors
Article first published online: 14 SEP 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 36, Issue 9, pages 858–865, November 2012
How to Cite
Papay, P., Primas, C., Eser, A., Novacek, G., Winkler, S., Frantal, S., Angelberger, S., Mikulits, A., Dejaco, C., Kazemi-Shirazi, L., Vogelsang, H. and Reinisch, W. (2012), Retesting for latent tuberculosis in patients with inflammatory bowel disease treated with TNF-α inhibitors. Alimentary Pharmacology & Therapeutics, 36: 858–865. doi: 10.1111/apt.12037
- Issue published online: 3 OCT 2012
- Article first published online: 14 SEP 2012
- Manuscript Accepted: 17 AUG 2012
- Manuscript Revised: 20 JUL 2012
- Manuscript Revised: 26 MAY 2012
- Manuscript Received: 1 MAY 2012
Patients treated with TNF-α inhibitors (TNFi) are at high risk of reactivation of latent tuberculosis (LTB). Prospective studies on monitoring of TB reactivation and/or infection in this risk group are lacking.
To test the conversion and reversion rate of screening tests for latent TB serial tuberculin skin test (TST) and interferon-γ release assay (IGRA) under ongoing TNFi therapy.
We retested consecutive patients with IBD receiving TNFi therapy for a minimum of 5 months for LTB using IGRA and TST. A detailed patient history and concomitant therapy were recorded for each subject.
After a median of 34.9 weeks (20.7–177.7), IGRA was retested in 184/227 patients (81.1%; Crohn's disease n = 139, ulcerative colitis n = 45) still under index TNFi. TST was available in 144/184 subjects (78.2%). The majority of patients were TNFi naïve (147/184, 79.9%). In a subgroup of patients who received isoniazid due to diagnosis of latent TB at baseline (n = 32), 6/13 patients (46.2%) with baseline positive IGRA and 3/22 patients (13.6%) with baseline positive TST reverted to negative at retesting. In patients without diagnosis of LTB at baseline no permanent IGRA conversion was observed, but there were 6/144 (4.2%) TST conversions from negative to positive. No single case of TB reactivation or infection was recorded during the observation period.
During treatment TNF-α inhibitors conversion was observed for tuberculin skin test, but not interferon-γ release assay. As compared with tuberculin skin test, interferon-γ release assay reverted in nearly half of isoniazid-treated patients for latent tuberculosis. However, the fact that patients in whom the interferon-γ release assay test result remained positive did not develop active tuberculosis during follow-up questions the utility of interferon-γ release assay as a monitoring tool during chemoprevention.