Carlos Taxonera1, Ángel Ponferrada2, Fernando Bermejo3, Sabino Riestra4, Cristina Saro5, María Dolores Martín-Arranz6, José Luis Cabriada7, Manuel Barreiro-de Acosta8, María Luisa de Castro9, Pilar López-Serrano10, Jesús Barrio11, Cristina Suarez12, Eva Iglesias13, Federico Argüelles-Arias14, Isabel Ferrer15, Ignacio Marín-Jiménez16, Alejandro Hernández-Camba17, Guillermo Bastida18, Manuel Van Domselaar19, Pilar Martínez-Montiel20, David Olivares1, Cristina Alba1, Javier P Gisbert21. 1. Inflammatory Bowel Disease Unit, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain. 2. Department of Gastroenterology, Hospital Infanta Leonor, Madrid, Spain. 3. Department of Gastroenterology, Hospital de Fuenlabrada, Madrid, Spain. 4. Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain. 5. Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain. 6. Department of Gastroenterology, Hospital La Paz, Madrid, Spain. 7. Department of Gastroenterology, Hospital de Galdakao, Galdakao, Spain. 8. Department of Gastroenterology, Hospital Clínico de Santiago, Santiago de Compostela, Spain. 9. Department of Gastroenterology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain. 10. Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Madrid, Spain. 11. Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain. 12. Department of Gastroenterology, Hospital Puerta de Hierro, Madrid, Spain. 13. Department of Gastroenterology, Hospital Reina Sofía, Córdoba, Spain. 14. Department of Gastroenterology, Hospitales Virgen Macarena-Rocío, Sevilla, Spain. 15. Department of Gastroenterology, Hospital de Manises, Manises, Spain. 16. Department of Gastroenterology, Hospital Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón [IiSGM], Madrid, Spain. 17. Department of Gastroenterology, Hospital Universitario de Canarias, La Laguna, Spain. 18. Department of Gastroenterology, Hospital La Fe, Valencia, Spain. 19. Department of Gastroenterology, Hospital de Torrejón, Madrid, Spain. 20. Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain. 21. Department of Gastroenterology, Hospital de la Princesa, CIBEREHD, Madrid, Spain.
Abstract
BACKGROUND AND AIM: Sensitivity of tuberculin skin test [TST] during screening for latent tuberculosis infection [LTBI] is affected by steroid and/or immunosuppressant therapy. The aim of this study was to compare performance of the two-step TST in inflammatory bowel disease patients immediately before anti-tumour necrosis factor [TNF] therapy as part of routine screening for LTBI vs control patients when the TST was carried out at an early stage. METHODS: In this multicentre prospective controlled study, we evaluated the performance of two-step TST with 5-mm threshold. Factors associated with TST results were determined by logistic regression. RESULTS: We evaluated 243 candidates for anti-TNF therapy and 337 control patients. Overall, 105 patients [18.1%] had an induration ≥ 5 mm in the first TST or in TST retest. LTBI was diagnosed in 25% of patients by TST retest. Twenty-eight [11.5%] anti-TNF group patients vs 77 [22.8%] control patients had a positive TST (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.28-0.70; P < 0.001]. In multivariate analysis, positive TST was associated with higher age [OR 2.63, 95% CI 1.21-5.72; P < 0.001] and 5-aminosalicylate therapy [OR 1.86, 95% CI 1.14-3.05; P = 0.013]. Negative TST was associated with steroid therapy [OR 0.36, 95% CI 0.16-0.83; P = 0.016], immunosuppressant therapy [OR 0.36, 95% CI 0.21-0.62; P < 0.001], or steroids + immunosuppressant therapy [OR 0.20, 95% CI 0.07-0.59; P = 0.004]. CONCLUSIONS: The sensitivity of routine TST performed just before starting anti-TNF therapy is low. TST performed at an early stage enables screening in the absence of immunosuppressive treatment and thus maximises the diagnostic yield of TST for detecting LTBI.
BACKGROUND AND AIM: Sensitivity of tuberculin skin test [TST] during screening for latent tuberculosis infection [LTBI] is affected by steroid and/or immunosuppressant therapy. The aim of this study was to compare performance of the two-step TST in inflammatory bowel disease patients immediately before anti-tumour necrosis factor [TNF] therapy as part of routine screening for LTBI vs control patients when the TST was carried out at an early stage. METHODS: In this multicentre prospective controlled study, we evaluated the performance of two-step TST with 5-mm threshold. Factors associated with TST results were determined by logistic regression. RESULTS: We evaluated 243 candidates for anti-TNF therapy and 337 control patients. Overall, 105 patients [18.1%] had an induration ≥ 5 mm in the first TST or in TST retest. LTBI was diagnosed in 25% of patients by TST retest. Twenty-eight [11.5%] anti-TNF group patients vs 77 [22.8%] control patients had a positive TST (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.28-0.70; P < 0.001]. In multivariate analysis, positive TST was associated with higher age [OR 2.63, 95% CI 1.21-5.72; P < 0.001] and 5-aminosalicylate therapy [OR 1.86, 95% CI 1.14-3.05; P = 0.013]. Negative TST was associated with steroid therapy [OR 0.36, 95% CI 0.16-0.83; P = 0.016], immunosuppressant therapy [OR 0.36, 95% CI 0.21-0.62; P < 0.001], or steroids + immunosuppressant therapy [OR 0.20, 95% CI 0.07-0.59; P = 0.004]. CONCLUSIONS: The sensitivity of routine TST performed just before starting anti-TNF therapy is low. TST performed at an early stage enables screening in the absence of immunosuppressive treatment and thus maximises the diagnostic yield of TST for detecting LTBI.
Authors: Flora Maria Lorenzo Fortes; Ney Boa Sorte; Victor D Mariano; Laíla D Andrade; Fernanda A Oliveira; Monique Ca Santos; Cláudia Ivanilda N Dos Santos; Catharina A Passos; Mila P Pacheco; Valdiana C Surlo; Neogélia P de Almeida; Jaciane Am Fontes; Andréa M Pimentel; Raquel Rocha; Genoile Oliveira Santana Journal: World J Gastroenterol Date: 2020-11-28 Impact factor: 5.742
Authors: Jun Won Park; Jeffrey R Curtis; Hajeong Lee; Jung-Kyu Lee; Yeong Wook Song; Eun Bong Lee Journal: PLoS One Date: 2020-12-31 Impact factor: 3.240
Authors: Sabino Riestra; Carlos Taxonera; Yamile Zabana; Daniel Carpio; María Chaparro; Jesús Barrio; Montserrat Rivero; Antonio López-Sanroman; María Esteve; Ruth de Francisco; Guillermo Bastida; Santiago García-López; Miriam Mañosa; María Dolores Martin-Arranz; José Lázaro Pérez-Calle; Jordi Guardiola; Fernando Muñoz; Laura Arranz; José Luis Cabriada; Mariana Fe García-Sepulcre; Mercè Navarro; Miguel Ángel Montoro-Huguet; Elena Ricart; Fernando Bermejo; Xavier Calvet; Marta Piqueras; Esther Garcia-Planella; Lucía Márquez; Miguel Mínguez; Manuel Van Domselar; Luis Bujanda; Xavier Aldeguer; Beatriz Sicilia; Eva Iglesias; Guillermo Alcaín; Isabel Pérez-Martínez; Valeria Rolle; Andrés Castaño-García; Javier P Gisbert; Eugeni Domènech Journal: J Clin Med Date: 2022-07-05 Impact factor: 4.964