Sunny H Wong1, Margaret Ip, Whitney Tang, Zheng Lin, Carmen Kee, Esther Hung, Grace Lui, Nelson Lee, Francis K L Chan, Justin C Wu, Joseph J Y Sung, Siew C Ng. 1. *Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Department of Medicine and Therapeutics, and LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China; †Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China; ‡Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, China; and §Division of Infectious Disease, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Abstract
BACKGROUND: Screening for latent tuberculosis (TB) is mandatory in inflammatory bowel disease (IBD) before starting anti-tumor necrosis factor therapy. Data on the utility of screening tests in populations with moderate background risk of TB are limited. This study aims to evaluate the performance of interferon-gamma release assay (IGRA) with QuantiFERON-TB Gold in IBD patients in a TB endemic region. METHODS: Two hundred sixty-eight consecutive adult IBD patients and 234 healthy controls were prospectively recruited. Detailed clinical history, chest x-ray findings, and IGRA results were documented for all individuals. The IGRA positive rates between IBD patients, with or without immunosuppressant, and healthy controls were compared. RESULTS: The IGRA result was positive in 21.9% of IBD patients and 19.2% of healthy controls (P = 0.535). IBD patients on immunosuppressive therapy had a significantly lower IGRA positive rate (13.0% versus 29.6%; P = 0.002) compared with immunosuppressant-naive IBD patients. This difference seemed to be most prominent for patients taking azathioprine (11.8% versus 27.3%, P = 0.006). CONCLUSIONS: IGRA results are negatively impacted by immunosuppressive therapy. Current guidelines suggesting TB screening before anti-tumor necrosis factor therapy may be inadequate in patients already on immunosuppressive drugs. Latent TB testing seems best performed before the initiation of immunosuppressive therapies in IBD patients.
BACKGROUND: Screening for latent tuberculosis (TB) is mandatory in inflammatory bowel disease (IBD) before starting anti-tumornecrosis factor therapy. Data on the utility of screening tests in populations with moderate background risk of TB are limited. This study aims to evaluate the performance of interferon-gamma release assay (IGRA) with QuantiFERON-TB Gold in IBDpatients in a TB endemic region. METHODS: Two hundred sixty-eight consecutive adult IBDpatients and 234 healthy controls were prospectively recruited. Detailed clinical history, chest x-ray findings, and IGRA results were documented for all individuals. The IGRA positive rates between IBDpatients, with or without immunosuppressant, and healthy controls were compared. RESULTS: The IGRA result was positive in 21.9% of IBDpatients and 19.2% of healthy controls (P = 0.535). IBDpatients on immunosuppressive therapy had a significantly lower IGRA positive rate (13.0% versus 29.6%; P = 0.002) compared with immunosuppressant-naive IBDpatients. This difference seemed to be most prominent for patients taking azathioprine (11.8% versus 27.3%, P = 0.006). CONCLUSIONS: IGRA results are negatively impacted by immunosuppressive therapy. Current guidelines suggesting TB screening before anti-tumornecrosis factor therapy may be inadequate in patients already on immunosuppressive drugs. Latent TB testing seems best performed before the initiation of immunosuppressive therapies in IBDpatients.
Authors: Saurabh Kedia; Raju Sharma; Govind K Makharia; Vineet Ahuja; Devendra Desai; Devasenathipathy Kandasamy; Anu Eapen; Karthik Ganesan; Uday C Ghoshal; Naveen Kalra; D Karthikeyan; Kumble Seetharama Madhusudhan; Mathew Philip; Amarender Singh Puri; Sunil Puri; Saroj K Sinha; Rupa Banerjee; Shobna Bhatia; Naresh Bhat; Sunil Dadhich; G K Dhali; B D Goswami; S K Issar; V Jayanthi; S P Misra; Sandeep Nijhawan; Pankaj Puri; Avik Sarkar; S P Singh; Anshu Srivastava; Philip Abraham; B S Ramakrishna Journal: Indian J Gastroenterol Date: 2018-01-06
Authors: Gaurav Syal; Mariastella Serrano; Animesh Jain; Benjamin L Cohen; Florian Rieder; Christian Stone; Bincy Abraham; David Hudesman; Lisa Malter; Robert McCabe; Stefan Holubar; Anita Afzali; Adam S Cheifetz; Jill K J Gaidos; Alan C Moss Journal: Inflamm Bowel Dis Date: 2021-10-18 Impact factor: 5.325