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Frequent conversion of tuberculosis screening tests during anti-tumour necrosis factor therapy in patients with rheumatic diseases
  1. Chrisoula Hatzara,
  2. Emilia Hadziyannis,
  3. Anna Kandili,
  4. Christos Koutsianas,
  5. Anastasia Makris,
  6. Georgios Georgiopoulos,
  7. Dimitrios Vassilopoulos
  1. 2nd Department of Medicine and Laboratory, National University of Athens Medical School, Hippokration General Hospital, Athens, Greece
  1. Correspondence to Dr Dimitrios Vassilopoulos, 2nd Department of Medicine and Laboratory, National University of Athens Medical School, Hippokration General Hospital, 114 Vass. Sophias Ave, Athens 115 27, Greece; dvassilop{at}med.uoa.gr

Abstract

Objectives 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.

  • Rheumatoid Arthritis
  • Anti-TNF
  • Tuberculosis

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