Prednisolone treatment affects the performance of the QuantiFERON gold in‐tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection

• Published in: Inflammatory bowel diseases 2011-11, Vol.17 (11), p.2340-2349
• Main Authors: Bélard, Erika, Semb, Synne, Ruhwald, Morten, Werlinrud, Anne Marie, Soborg, Bolette, Jensen, Frank Krieger, Thomsen, Henrik, Brylov, Annette, Hetland, Merete Lund, Nordgaard‐Lassen, Inge, Ravn, Pernille
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anti-Inflammatory Agents - pharmacology; anti‐TNF‐α treatment; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; autoimmune disease; Autoimmune diseases; Autoimmune Diseases - complications; Autoimmune Diseases - diagnosis; Autoimmune Diseases - drug therapy; azathioprine; Chest; Cohort Studies; Corticoids; corticosteroid; Crohn's disease; Data processing; Female; Follow-Up Studies; gamma -Interferon; Gold; Gold - chemistry; Humans; IGRA; Immunosuppressive agents; Immunosuppressive Agents - pharmacology; Infection; Inflammatory bowel diseases; Interferon; Interferon-gamma - metabolism; Intestine; Ionizing radiation; Latent Tuberculosis - complications; Latent Tuberculosis - diagnosis; Latent Tuberculosis - drug therapy; Male; Methotrexate; Middle Aged; Mitogens; Mycobacterium tuberculosis; Prednisolone; Prednisolone - pharmacology; Prognosis; Prospective Studies; Rheumatoid arthritis; Risk Factors; Skin tests; Tuberculin; Tuberculin Test - instrumentation; Tuberculin Test - methods; Tuberculosis; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor Necrosis Factor-alpha - metabolism; Ulcerative colitis; Young Adult
• ISSN: 1078-0998; 1536-4844; 1536-4844
• DOI: 10.1002/ibd.21605

Background: During screening for latent tuberculosis infection (LTBI), before anti‐tumor‐necrosis‐factor‐α treatment, most patients are already receiving immunosuppressive therapy. The objective was to evaluate the performance of the QuantiFERON Gold In‐Tube (QFT‐IT) and the Tuberculin Skin Test (TST). Methods: A prospective multicenter study included 248 patients with ulcerative colitis (39), Crohn's disease (54), rheumatoid arthritis (111), and spondylo‐arthropathy (44). Results: QFT‐IT was positive in 7/248 (3%), negative in 229 (92%), and indeterminate in 12 (5%). TST was positive in 54/238 (23%) patients. Chest x‐ray was suspect for tuberculosis in 5/236 (2%), and 35/167 (21%) had ≥1 risk‐factors for infection with Mycobacterium tuberculosis. The main finding was a pronounced negative effect on QFT‐IT and TST performance associated with prednisolone treatment. During prednisolone treatment interferon gamma (IFN‐γ) response to mitogen stimulation was impaired (median IFN‐γ response 4.9 IU/mL; interquartile range [IQR] 0.8 to ≥10.0) compared to patients 1) not receiving corticosteroids (median ≥10.0; IQR 5.0 to ≥10.0; P = 0.0015) or 2) receiving long‐acting corticosteroids (median >10.0; IQR 9.7 to >10.0; P = 0.0058). Prednisolone treatment was strongly associated with negative TST, adjusted odds ratio (AOR) 0.22 (0.1–0.8; P = 0.018), and with an increased risk of indeterminate QFT‐IT results AOR 16.1 (4.1–63.2; P < 0.001), whereas no negative effect was found for long‐acting corticosteroids. Doses of ≥10 mg prednisolone were associated with a 27% risk of indeterminate results. Single use of azathioprine, methotrexate, or 5‐aminosalicylate (5‐ASA) did not affect the test results. Conclusions: Oral prednisolone severely suppressed QFT‐IT and TST performance, whereas the long‐acting corticosteroids methotrexate, azathioprine, and 5‐ASA did not have a similar detrimental effect. Patients should be screened for LTBI with QFT‐IT or TST prior to initiation of prednisolone therapy and negative QFT‐IT or TST results interpreted with caution in patients treated with any corticosteroid until further data are available. (Inflamm Bowel Dis 2011;)