Concordance Between the QuantiFERON-TB Gold In-Tube and Tuberculin Test for the Diagnosis of Latent Tuberculosis Infection in Patients with Rheumatic Diseases

Cristobal Pavez Perales¹, Ana Quiles Rocher², Elena Grau Garcia³, Marta De la Rubia Navarro¹, Samuel Leal Rodriguez⁴, Roxana Gonzalez Mazario¹, Jorge Juan Fragio Gil¹, Cristina Alcañiz Escandell³, Jose Ivorra Cortes¹, Inmaculada Chalmeta Verdejo¹, Luis Gonzalez Puig⁵, Isabel Martinez Cordellat¹, Rosa Negueroles Albuixech¹, Jose Eloy Oller Rodriguez¹, Francisco Miguel Ortiz Sanjuan⁴, Elvira Vicens Bernabeu⁴, Carmen Najera Herranz¹, Ines Canovas Olmos¹ and Jose Andres Roman Ivorra¹, ¹Rheumatology Department. HUP La Fe, Valencia, Spain, ²Medical School, UCV, Valencia, Valencia, Spain, ³Rheumatology Department. HUP La Fe, Valencia, Comunidad Valenciana, Spain, ⁴Rheumatology Department, HUP La Fe, Valencia, Spain, ⁵Rheumatology Department. HUP La Fe, Torrente ( Valencia), Spain

Meeting: ACR Convergence 2020

Keywords: autoimmune diseases, Biologicals, Infection, Miscellaneous Rheumatic and Inflammatory Diseases, Spondylarthropathies

Session Information

Date: Friday, November 6, 2020

Title: Miscellaneous Rheumatic & Inflammatory Diseases Poster I: Diagnosis and Testing

Session Type: Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with rheumatic diseases (RD) are at higher risk of latent tuberculosis infection (LTBI) reactivation. To detect and treat it before starting treatment, especially with biological therapies, decrease the reactivation risk. Diagnosis is carried out by the tuberculin skin test (TST) or interferon-gamma release assays (IGRAs), IGRAs might be more specific and sensitive. We aim to analyze the concordance between QuantiFERON-TB Gold In-Tube (QTF) and TST for the diagnosis of LTBI in patients with rheumatic diseases.

Methods: A retrospective observational study was conducted including patients diagnosed with RD screened for LTBI with both TST and QTF (2014-2018). Demographical and clinical variables at screening and at follow-up were collected. The concordance between both tests has been estimated as categorical variables using Cohen´s Kappa test, considering “poor” if it is ≤ 0,20; “low” if 0,20 < k ≤ 0,40, “moderate” if 0,40 < k ≤ 0,60, “substantial” if 0,60 < k ≤ 0,80 and “optimal” if k > 0,80.

Results: 167 patients were included (57% women) with a mean age of 52±16 years. 42% of them had systemic autoimmune diseases, 22% spondyloarthropathies and 36% other RD. 2 had history of past active tuberculosis (TB). At the time of screening, 46.11% were treated with GC.

LTBI was diagnosed in 35 patients: 15 had both QTF and TST positive, 16 only QTF positive and 4 only TST positive. 12 from 31 QTF positive patients were treated with GC at the time of screening. 3 from 19 TST positive patients were treated with GC at the time of screening.

After LTBI screening 62 patients received biological treatment, 4 of them had both test positive, 6 only QTF positive and 2 only TST positive. 11 received LTBI treatment according to the hospital protocol (isoniazid for 6 to 9 months). 10 completed treatment, 1 did not because of intolerance and did not receive other treatment. 1 patient with only TST positive was considered a false positive and did not receive treatment. During follow-up no TB reactivation was reported.

23 patients with LBTI received treatment other than biological therapy during follow-up, of them 8 received LBTI treatment. There was no TB reactivation during follow up.

The Kappa concordance between QTF and TST was estimated: moderated in the whole sample, poor in the patients treated with GC at screening, and substantial when the patients treated with GC at screening were excluded. Results are shown in Table 1.

	TOTAL SAMPLE	PATIENTS WITH GC AT LTBI SCREENING	PATIENTS WITHOUT GC AT LTBI SCREENING
Number of coincidences (p1)	147 (88.02%)	64 (83.12%)	83 (92.22%)
Number of randomly expected coincidences (p_e)	124.1 (74.28%)	62.9 (81.73%)	61.8 (68.62%)
Kappa = p1- p_e /1- p_e	0,534	0,117	0.752
IC 95%	(0.358-0.710)	(-0.154-0.305)	(0.579-0.926)

Table 1. Kappa concordance between QTF and TST.

Conclusion: QTF seems to be the most appropriate LTBI screening test in patients with RD treated with GC. Screening and treatment of LTBI in patients with RD treated with or without biological agents was effective in reducing TB reactivation.

Disclosure: C. Pavez Perales, None; A. Quiles Rocher, None; E. Grau Garcia, None; M. De la Rubia Navarro, None; S. Leal Rodriguez, None; R. Gonzalez Mazario, None; J. Fragio Gil, None; C. Alcañiz Escandell, None; J. Ivorra Cortes, None; I. Chalmeta Verdejo, None; L. Gonzalez Puig, None; I. Martinez Cordellat, None; R. Negueroles Albuixech, None; J. Oller Rodriguez, None; F. Ortiz Sanjuan, None; E. Vicens Bernabeu, None; C. Najera Herranz, None; I. Canovas Olmos, None; J. Roman Ivorra, None.

To cite this abstract in AMA style:

Pavez Perales C, Quiles Rocher A, Grau Garcia E, De la Rubia Navarro M, Leal Rodriguez S, Gonzalez Mazario R, Fragio Gil J, Alcañiz Escandell C, Ivorra Cortes J, Chalmeta Verdejo I, Gonzalez Puig L, Martinez Cordellat I, Negueroles Albuixech R, Oller Rodriguez J, Ortiz Sanjuan F, Vicens Bernabeu E, Najera Herranz C, Canovas Olmos I, Roman Ivorra J. Concordance Between the QuantiFERON-TB Gold In-Tube and Tuberculin Test for the Diagnosis of Latent Tuberculosis Infection in Patients with Rheumatic Diseases [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/concordance-between-the-quantiferon-tb-gold-in-tube-and-tuberculin-test-for-the-diagnosis-of-latent-tuberculosis-infection-in-patients-with-rheumatic-diseases/. Accessed .

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