title: Retesting for latent tuberculosis in patients with inflammatory bowel disease treated with TNF-α inhibitors.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Papay
authors.forename: C
authors.initials: C
authors.lastname: Primas
authors.forename: A
authors.initials: A
authors.lastname: Eser
authors.forename: G
authors.initials: G
authors.lastname: Novacek
authors.forename: S
authors.initials: S
authors.lastname: Winkler
authors.forename: S
authors.initials: S
authors.lastname: Frantal
authors.forename: S
authors.initials: S
authors.lastname: Angelberger
authors.forename: A
authors.initials: A
authors.lastname: Mikulits
authors.forename: C
authors.initials: C
authors.lastname: Dejaco
authors.forename: L
authors.initials: L
authors.lastname: Kazemi-Shirazi
authors.forename: H
authors.initials: H
authors.lastname: Vogelsang
authors.forename: W
authors.initials: W
authors.lastname: Reinisch
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000276:immunology / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy* / Q000382:microbiology; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D014374:Tuberculin Test / Q000379:methods*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha