Session Type: Abstract Submissions (ACR)
Anti-tumor necrosis factor (TNF) treatments may increase tuberculosis. Most of the national guidelines recommend tuberculin skin test (TST) for screening of latent tuberculosis. However, BCG vaccine is mandatory in some countries and TST may be positive in more than 80% of those country1. Thus, vast majority of those patients use isoniazid prophylaxis and this drug is not innocent. Objective of this study was to assess accuracy of QuantiFERON-TB Gold In-Tube (QFT-GIT) test for anti-tuberculosis prophylaxis during anti-TNF treatment.
Methods: TST have been used for detection of latent tuberculosis between 2003-2011 in our center. After March 2011, QFT-GIT test was replaced TST for these purpose in routine practice. All patients who started anti-TNF therapy were recorded in a database prospectively between March 2011 to June 2013 according to QFT-GIT test results. This database included name of anti-TNF drugs, switch of anti-TNF, duration of follow-up. Clinical signs of tuberculosis were examined every 3 months by physicians or experienced study nurses. Isoniazid prophylaxis started in patients with positive QFT-GIT test . In June 2013, all database screened regularly by a physician. If patients were not examined in last 3 months, patients were called by phone [112/516 (21,7%)] for drug survival and signs of tuberculosis. If patients were not reached by phone, data of tuberculosis extracted from “tuberculosis control dispensary of health ministry” [24/516 (6,2%) patients].
Results: A total of 516 (289 female, 56%) patients were started anti-TNF therapy. Mean age of patients were 40 ± 12 years. Initial diagnosis of patients were spondyloarthritis 309 (59,9%), rheumatoid arthritis 158 (30,6%), psoriatic arthritis 45 (8,7%) and juvenil idiopathic arthritis 4 (0,8%). Anti-TNF drugs were adalimumab 191 (37,0%), etanercept 177 (34,3%), infliximab 133 (25,8%) and golimumab 15 (2,9%). Anti-TNF drugs was switched in 64 (12,4%) patients. QFT-GIT test was found to be positive in 110 (21,6%) patients. Isoniazid prophylaxis started in those patients. Median follow-up duration of patients were 5 (0-24) months and 191 of 516 (37,0%) patients were followed more than 9 months. Patients were classified as follows; regularly follow-up 344 (66.7%), just started within last 3 months 60 (11,6%), never follow-up 47 (9.1%), and irregularly follow-up 65 (12,6%). None of the patients from this cohort had tuberculosis.
Conclusion: BCG vaccine is mandatory in our country. Unfortunately, BCG vaccine affects adversely on TST for detection of latent tuberculosis. Although median follow-up duration is limited in this study, QFT-GIT test may be effective and reliable alternative for detection of latent tuberculosis before commencement of anti-TNF treatment in real life.
Reference: 1Kalyoncu U et al. Comparison of quantiferon-TB test and TST in routine practice during anti-TNF treatment. Ann Rheum Dis 2013;72(Suppls3):231
A. C. Inkaya,
S. Apras Bilgen,
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