BACKGROUND: Patients undergoing tumour necrosis factor (TNF)-α antagonist therapy are at increased risk of latent tuberculosis infection (LTBI) reactivation. The aim of this study was to determine the optimum available screening strategy for identifying patients for tuberculosis (TB) chemoprophylaxis. METHODS: We conducted a prospective observational study of consecutive adults with chronic rheumatological disease referred for LTBI screening prior to commencement of TNF-α antagonist therapy. All patients included had calculation of TB risk according to age, ethnicity and year of UK entry, as described in the 2005 British Thoracic Society (BTS) guidelines and measurement of tuberculin skin test (TST) and T.Spot.TB. RESULTS: There were 187 patients included in the study, with 157 patients (84%) taking immunosuppressants. 137 patients would require further risk stratification according to the BTS algorithm, with 110 (80.3%) classified as being at low risk of having LTBI. There were 39 patients (35.5%) who were categorised as low risk but were either TST and/or T.Spot positive and would not have received chemoprophylaxis according to the BTS algorithm. Combination of all three methods (risk stratification and/or positive T.Spot and/or positive TST) identified 66 patients out of 137 who would potentially be offered chemoprophylaxis, which was greater than any single test or two-test combination. CONCLUSION: Performing both a TST and T.Spot in patients on immunosuppressants prior to commencement of TNF-α antagonist therapy gives an additional yield of potential LTBI compared with use of risk stratification tables alone. Our results suggest that use of all three screening modalities gives the highest yield of patients potentially requiring chemoprophylaxis.
BACKGROUND:Patients undergoing tumour necrosis factor (TNF)-α antagonist therapy are at increased risk of latent tuberculosis infection (LTBI) reactivation. The aim of this study was to determine the optimum available screening strategy for identifying patients for tuberculosis (TB) chemoprophylaxis. METHODS: We conducted a prospective observational study of consecutive adults with chronic rheumatological disease referred for LTBI screening prior to commencement of TNF-α antagonist therapy. All patients included had calculation of TB risk according to age, ethnicity and year of UK entry, as described in the 2005 British Thoracic Society (BTS) guidelines and measurement of tuberculin skin test (TST) and T.Spot.TB. RESULTS: There were 187 patients included in the study, with 157 patients (84%) taking immunosuppressants. 137 patients would require further risk stratification according to the BTS algorithm, with 110 (80.3%) classified as being at low risk of having LTBI. There were 39 patients (35.5%) who were categorised as low risk but were either TST and/or T.Spot positive and would not have received chemoprophylaxis according to the BTS algorithm. Combination of all three methods (risk stratification and/or positive T.Spot and/or positive TST) identified 66 patients out of 137 who would potentially be offered chemoprophylaxis, which was greater than any single test or two-test combination. CONCLUSION: Performing both a TST and T.Spot in patients on immunosuppressants prior to commencement of TNF-α antagonist therapy gives an additional yield of potential LTBI compared with use of risk stratification tables alone. Our results suggest that use of all three screening modalities gives the highest yield of patients potentially requiring chemoprophylaxis.
Authors: Tina Ding; Jo Ledingham; Raashid Luqmani; Sarah Westlake; Kimme Hyrich; Mark Lunt; Patrick Kiely; Marwan Bukhari; Rikki Abernethy; Ailsa Bosworth; Andrew Ostor; Kate Gadsby; Frank McKenna; Diana Finney; Josh Dixey; Chris Deighton Journal: Rheumatology (Oxford) Date: 2010-09-12 Impact factor: 7.580
Authors: Tim Bongartz; Alex J Sutton; Michael J Sweeting; Iain Buchan; Eric L Matteson; Victor Montori Journal: JAMA Date: 2006-05-17 Impact factor: 56.272
Authors: Patricio Escalante; Kirstin J Kooda; Rizwana Khan; San San Aye; Stratos Christianakis; Daniel G Arkfeld; Glenn R Ehresmann; Jens J Kort; Brenda E Jones Journal: Lung Date: 2014-10-16 Impact factor: 2.584
Authors: Yi-Hsing Chen; Hellen Mds de Carvalho; Umut Kalyoncu; Lyndon John Q Llamado; Gaston Solano; Ron Pedersen; Galina Lukina; Juan J Lichauco; Radu S Vasilescu Journal: Biologics Date: 2018-01-12