ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1372

Do We Really Identify Latent Tuberculosis? Comparison Of The Performance Of Tuberculin Skin Test and Interferon Gamma Release Assay Before Biologics: A Systematic Review and Meta-Analysis

Marie Locci1, Françoise Barchechath-Flaisler2, Jean-Louis Leroux1 and Cécile Gaujoux-Viala3, 1Nîmes University Hospital, Rheumatology Department, Nîmes, France, 2Nîmes University Hospital, Rheumatology Department, Nimes, France, 3EA 2415, Montpellier I University, Nîmes University Hospital, Rheumatology Department, Nîmes, France

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects II: Predictors of Disease Course in Rheumatoid Arthritis - Treatment Approaches

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Current guidelines mandate screening for latent tuberculosis infection prior to commencing anti-tumor necrosis factor therapy. However, many patients are already taking immunosuppressive therapy, which can affect current diagnostic tests. Due to the recent introduction of the interferon-gamma release assays (IGRA), we sought out to assess their ability to detect latent tuberculosis infections in patients before biotherapy and the impact of immunosuppressive therapy on these new tests.

Methods: MEDLINE, EMBASE and COCHRANE were searched (up to April 2013) to identify studies evaluating the performance of  interferon-gamma release assays (QuantiFERON QTF, T-SPOT.TB) compared to the performance of  Tuberculin Skin Test (TST) in individuals candidates for anti TNF treatment, with inflammatory bowel disease or rheumatic disease.

Results:

On 533 studies, 45 studies (n= 9226 patients) were included for analysis. The agreement between IDR/IGRA was poor. Kappas between QTF and TST were calculated in 18 studies, ranging from 0.03 to 0.52: poor in 15 studies (<0.4) and moderate in 3 studies (0.4-0.6). Kappas between T-SPOT and TST were calculated in 7 studies, ranging from 0.13 to 0.40: poor in 6 studies and moderate in 1 study. Moreover, the agreement between the two IGRA was moderate. Kappas ranged from 0.28 to 0.71 in 8 studies: poor in 1 study, moderate in 5 studies and good in only 2 studies.

Immunosuppressive therapy did not significantly influence positive QTF results (pooled OR 0.86, 95% CI 0.56 – 1.33) and positive T-SPOT results (pooled OR 0.74, 95% CI 0.46 – 1.21).

Conclusion:

The screening of latent tuberculosis raises concerns, especially due to the lack of agreement between IGRA. The impact of immunosuppressive therapy on IGRA was not significant.

Disclosure:

M. Locci,
None;

F. Barchechath-Flaisler,
None;

J. L. Leroux,
None;

C. Gaujoux-Viala,
None.

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/do-we-really-identify-latent-tuberculosis-comparison-of-the-performance-of-tuberculin-skin-test-and-interferon-gamma-release-assay-before-biologics-a-systematic-review-and-meta-analysis/