The tuberculin skin test still matters for the screening of latent Tuberculosis infections among Inflammatory Bowel Disease patients.
OBJECTIVE
There is a high risk of Tuberculosis among patients medicated with anti-tumour necrosis factor α (anti-TNFα) that can be mitigated by treating latent Tuberculosis infections (LTI). This study aimed to evaluate the performance of Tuberculin Skin test (TST) and Quantiferon-TB Gold in Tube (QFT-GIT) in a population of patients suffering from Inflammatory Bowel Diseases.


METHODS
The cohort analyzed in this study consisted of 250 patients, of whom 15% were therapy-naïve and 85% were medicated: 70% under immunosuppressive therapy and 30% on anti-TNFα. A LTBI was diagnosed following a positive result in either of the tests and their performance and concordance were evaluated.


RESULTS
Fifty-eight and 24 patients had a positive TST and QFT-GIT, respectively. In 72 (29%) patients LTBI was diagnosed, of whom 8 (21%) were therapy-naïve. TST had an overall higher sensitivity (81% vs. 35%) and a higher Negative Predictive Value (93% vs. 80%) when compared to QFT-GIT test; this superiority was consistently maintained irrespective of the presence and kind of backbone immunosuppressive therapies. The concordance between both tests was weak.


CONCLUSIONS
Our results underscore the need to maintain the TST on LTBI diagnosis in patients about to start or switch anti-TNFα therapy in an intermediate Tuberculosis incidence context.
Instituto de Inovação e Investigação em Saúde (I3S), Portugal. Electronic address: candida.abreu@gmail.com.
Cândida
C
Abreu
Instituto de Inovação e Investigação em Saúde (I3S), Portugal. Electronic address: franciscomlrmalmeida@gmail.com.
Francisco
F
Almeida
Instituto de Inovação e Investigação em Saúde (I3S), Portugal. Electronic address: ferrazrit@gmail.com.
Rita
R
Ferraz
Grupo de I&D em Nefrologia e Doenças Infecciosas, Portugal. Electronic address: camila@med.up.pt.
Claúdia Camila
CC
Dias
Instituto de Inovação e Investigação em Saúde (I3S), Portugal. Electronic address: asarmento@med.up.pt.
António
A
Sarmento
Instituto Nacional de Engenharia Biomédica (INEB), Portugal. Electronic address: fm@med.up.pt.
Fernando
F
Magro
D000068879:Adalimumab / Q000627:therapeutic use; D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy*; D000069285:Infliximab / Q000627:therapeutic use; D055985:Latent Tuberculosis / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab
Anti-TNFα; QuantiFERON-TB Gold In-Tube