Retesting for latent tuberculosis in patients with inflammatory bowel disease treated with TNF-α inhibitors

• Published in: Alimentary pharmacology & therapeutics 2012-11, Vol.36 (9), p.858-865
• Main Authors: Papay, P., Primas, C., Eser, A., Novacek, G., Winkler, S., Frantal, S., Angelberger, S., Mikulits, A., Dejaco, C., Kazemi-Shirazi, L., Vogelsang, H., Reinisch, W.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bacterial diseases; Biological and medical sciences; Digestive system; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Agents - therapeutic use; Human bacterial diseases; Humans; Immunosuppressive Agents - immunology; Immunosuppressive Agents - therapeutic use; Infectious diseases; Inflammatory Bowel Diseases - drug therapy; Inflammatory Bowel Diseases - microbiology; Interferon-gamma Release Tests; Latent Tuberculosis - complications; Latent Tuberculosis - diagnosis; Latent Tuberculosis - immunology; Male; Medical sciences; Other diseases. Semiology; Pharmacology. Drug treatments; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tuberculin Test - methods; Tuberculosis and atypical mycobacterial infections; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Young Adult
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.12037

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.