OBJECTIVES: The risk of active tuberculosis increases in rheumatoid arthritis (RA) patients receiving antitumour necrosis factor alpha (TNFα) therapy. Longitudinal data concerning serial interferon γ (IFNγ) assays for detecting tuberculosis have been limited. This study investigated the time course of the development of active tuberculosis, and evaluated the utility of serial QuantiFERON-TB Gold (QFT-G) assays for detecting its emergence in RA patients undergoing long-term anti-TNFα therapy. METHODS: 242 RA patients who received anti-TNFα therapy and serial QFT-G assays were prospectively evaluated. QFT-G was performed by measuring IFNγ levels in whole blood treated with tuberculosis-specific antigens. RESULTS: Among 242 RA patients, 75 (31.0%) had a positive tuberculin skin test (TST) and 45 (18.6%) had positive QFT-G results, with another nine (3.7%) showing indeterminate QFT-G assay. Isoniazid prophylaxis was given to 37 patients with TST+/QFT-G+ results and 24 TST+/QFT-G- patients with TST induration diameter ≧10 mm. Four patients (three with baseline QFT-G+ results) developed tuberculosis within the first 3 months of anti-TNFα therapy, whereas five patients with baseline TST-/QFT-G- results developed active tuberculosis after 20-24 months' anti-TNFα therapy. Progressively rising levels of released IFNγ (2.17 ± 0.98 vs 5.93 ± 2.92 IU/ml in early secretory antigenic target-6-stimulated well; 1.12 ± 0.84 vs 2.96 ± 1.02 IU/ml in culture filtrate protein-10-stimulated well) were observed in those who developed tuberculosis early in anti-TNFα therapy. QFT-G conversion was found in baseline QFT-G-negative patients who developed tuberculosis late in treatment. CONCLUSION: The emergence of active tuberculosis follows a biphasic pattern. Persistently high levels of released IFNγ or QFT-G conversion strongly indicate the development of active tuberculosis in patients undergoing long-term anti-TNFα therapy.
OBJECTIVES: The risk of active tuberculosis increases in rheumatoid arthritis (RA) patients receiving antitumour necrosis factor alpha (TNFα) therapy. Longitudinal data concerning serial interferon γ (IFNγ) assays for detecting tuberculosis have been limited. This study investigated the time course of the development of active tuberculosis, and evaluated the utility of serial QuantiFERON-TB Gold (QFT-G) assays for detecting its emergence in RApatients undergoing long-term anti-TNFα therapy. METHODS: 242 RApatients who received anti-TNFα therapy and serial QFT-G assays were prospectively evaluated. QFT-G was performed by measuring IFNγ levels in whole blood treated with tuberculosis-specific antigens. RESULTS: Among 242 RApatients, 75 (31.0%) had a positive tuberculin skin test (TST) and 45 (18.6%) had positive QFT-G results, with another nine (3.7%) showing indeterminate QFT-G assay. Isoniazid prophylaxis was given to 37 patients with TST+/QFT-G+ results and 24 TST+/QFT-G- patients with TST induration diameter ≧10 mm. Four patients (three with baseline QFT-G+ results) developed tuberculosis within the first 3 months of anti-TNFα therapy, whereas five patients with baseline TST-/QFT-G- results developed active tuberculosis after 20-24 months' anti-TNFα therapy. Progressively rising levels of released IFNγ (2.17 ± 0.98 vs 5.93 ± 2.92 IU/ml in early secretory antigenic target-6-stimulated well; 1.12 ± 0.84 vs 2.96 ± 1.02 IU/ml in culture filtrate protein-10-stimulated well) were observed in those who developed tuberculosis early in anti-TNFα therapy. QFT-G conversion was found in baseline QFT-G-negative patients who developed tuberculosis late in treatment. CONCLUSION: The emergence of active tuberculosis follows a biphasic pattern. Persistently high levels of released IFNγ or QFT-G conversion strongly indicate the development of active tuberculosis in patients undergoing long-term anti-TNFα therapy.
Authors: I Sauzullo; R Scrivo; F Mengoni; A Ermocida; M Coppola; G Valesini; V Vullo; C M Mastroianni Journal: Clin Exp Immunol Date: 2014-06 Impact factor: 4.330
Authors: Sang Kook Lee; Song Yee Kim; Eun Young Kim; Ji Ye Jung; Moo Suk Park; Young Sam Kim; Se Kyu Kim; Joon Chang; Young Ae Kang Journal: Lung Date: 2013-06-01 Impact factor: 2.584