Frequent conversion of tuberculosis screening tests during anti-tumour necrosis factor therapy in patients with rheumatic diseases.
OBJECTIVE
To determine the rate of tuberculosis (TB) screening test conversion during anti-tumour necrosis factor (TNF) therapy in rheumatic patients with negative baseline screening.


METHODS
This was a prospective study of rheumatic patients with negative baseline TB screening (tuberculin skin test (TST): <5 mm, and negative T-SPOT.TB, QuantiFERON-TB Gold In Tube (QFT-GIT) and chest X-ray) treated with anti-TNF agents. All patients underwent re-screening for TB with all assays 1 year later. Factors associated with TB test conversion were analysed and compared between 'converters' and 'non-converters'.


RESULTS
Seventy patients (mean age 50.6±15.5 years) with rheumatic disease (33 with rheumatoid arthritis, 33 with spondyloarthropathies and 4 with other conditions) were enrolled. Patients were treated with different anti-TNFs (27 with adalimumab, 14 etanercept, 16 infliximab, 8 golimumab, 5 certolizumab pegol) for 1 year. Twenty patients (29%) displayed conversion of at least one screening assay 12 months after anti-TNF therapy: conversion of TST occurred in 9 (13%), T-SPOT.TB in 7 (10%) and QFT-GIT in 5 (7%). Only one patient had concomitant conversion of more than one screening test. Univariate and multivariate analysis revealed that only infliximab was associated with a decreased rate of TB screening assay conversion (OR 0.048, 95% CI 0.004 to 0.606, p=0.017). No patient (40% received isoniazid therapy) developed active TB during follow-up (27±12 months).


CONCLUSIONS
Approximately one third of patients with negative baseline TB screening develop conversion of at least one screening test during anti-TNF treatment. These findings should be considered when designing re-screening strategies and contemplating latent TB therapy.
2nd Department of Medicine and Laboratory, National University of Athens Medical School, Hippokration General Hospital, Athens, Greece.
Chrisoula
C
Hatzara
2nd Department of Medicine and Laboratory, National University of Athens Medical School, Hippokration General Hospital, Athens, Greece.
Emilia
E
Hadziyannis
2nd Department of Medicine and Laboratory, National University of Athens Medical School, Hippokration General Hospital, Athens, Greece.
Anna
A
Kandili
2nd Department of Medicine and Laboratory, National University of Athens Medical School, Hippokration General Hospital, Athens, Greece.
Christos
C
Koutsianas
2nd Department of Medicine and Laboratory, National University of Athens Medical School, Hippokration General Hospital, Athens, Greece.
Anastasia
A
Makris
2nd Department of Medicine and Laboratory, National University of Athens Medical School, Hippokration General Hospital, Athens, Greece.
Georgios
G
Georgiopoulos
2nd Department of Medicine and Laboratory, National University of Athens Medical School, Hippokration General Hospital, Athens, Greece.
Dimitrios
D
Vassilopoulos
D000293:Adolescent; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D007371:Interferon-gamma / Q000096:biosynthesis; D059425:Interferon-gamma Release Tests / Q000379:methods; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D014374:Tuberculin Test / Q000379:methods; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D018501:Antirheumatic Agents; C439524:TNF protein, human; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma
Anti-TNF; Rheumatoid Arthritis; Tuberculosis