Session Title: Infection-related Rheumatic Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose: The most recent ACR Recommendations suggest annual screening for latent tuberculosis (TB) with standard tuberculin skin test (TST) or the newer interferon-gamma release assays (IGRAs), in patients with rheumatoid arthritis (RA) receiving biologics and risk factors for TB exposure. The rate and clinical significance of TB test conversion during biologic treatment, especially with anti-tumor necrosis factor (TNF) agents, has not been adequately studied so far. Our aim was to determine prospectively the rate of TB test conversion (TST, IGRAs) during anti-TNF therapy in patients with negative baseline screening.
Methods: Among a large cohort of rheumatic patients starting anti-TNF therapy, 50 consecutive patients with negative baseline TB screening (TST: < 5 mm, negative T.Spot®-TB and QuantiFERON®-TB Gold In Tube/QFT-GIT, negative CXR) were followed prospectively during anti-TNF therapy. One year later all patients underwent re-testing for TB with TST, both IGRAs and repeat CXR. Patients with a TB test conversion or changes in CXR underwent further evaluation for active TB.
Results: 50 patients (females/males=29/21, mean age=49.6±15 years) with various rheumatic diseases (RA: n=23, spondyloarthropathies/SpA: n=26, other: n=1) were enrolled in the study. Patients were treated with various anti-TNFs (adalimumab=20, etanercept=13, infliximab=13, golimumab=3, certolizumab=1) for one year. Retesting after one year, showed that 15 patients (30%) displayed conversion of at least one screening assay. Fourteen percent showed conversion of TST (n=7), 10% of T.Spot®-TB (n=5) and 6% of QFT-GIT (n=3). No patient had concomitant conversion of ≥ 2 screening tests while there was no history of remote or recent documented TB contact in the converted patients. Further work-up did not reveal any evidence of active TB in these patients. There were no significant differences in age, sex, disease diagnosis or duration, previous BCG vaccination, concomitant DMARD and/or steroid use or type of anti-TNF treatment between those who converted (n=15) vs those who did not (n=35).
Conclusion: Approximately one third of patients with negative TB screening at baseline develop conversion of at least one screening test during anti-TNF treatment. The clinical significance of these findings as well as the need for latent TB therapy in this patient group needs to be studied further.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/frequent-conversion-of-tuberculosis-screening-tests-during-anti-tumor-necrosis-factor-therapy-in-patients-with-rheumatic-diseases/