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Zavala Del Ángel AE, Morales-Romero J, Zenteno-Cuevas R, Enciso Moreno JA, Mata Miranda MDP, Martínez Zapata JL, Sampieri Ramírez CL, Nachón García MG, Blázquez Morales MSL, Álvarez-Bañuelos MT, Cruz López JA, Demeneghi-Marini VP, González-López L, Gámez-Nava JI. Prevalence of Latent Tuberculosis Infection (LTBI) in Mexican Patients With Rheumatoid Arthritis (RA). Cureus 2023; 15:e39743. [PMID: 37398734 PMCID: PMC10310548 DOI: 10.7759/cureus.39743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Patients with rheumatoid arthritis (RA) are at increased risk of developing tuberculosis, and even more so if they receive biological agents. In Mexico, the prevalence of latent tuberculosis infection (LTBI) in RA diagnosed by interferon-gamma release assay (IGRA) is largely unknown. The objective was to determine LTBI prevalence and the associated risk factors in rheumatoid arthritis patients. METHODS A cross-sectional study was performed comprising 82 patients with RA who attended the rheumatology service at a second-level hospital. Demographic characteristics, comorbidity, Bacillus Calmette-Guerin (BCG) vaccination and smoking history, type of treatment, disease activity and functional capacity were investigated. The Disease Activity Score 28 and the Health Assessment Questionnaire-Disability Index were applied for the estimate of RA activity and functional capacity. Further information was compiled from the electronic medical records and personal interviews. LTBI was determined by QuantiFERON TB Gold Plus (QIAGEN, Germantown, USA). RESULTS Prevalence of LTBI was 14% (95% confidence interval (CI): 8.6% to 23.9%). Factors associated with LTBI were history of smoking (odds ratio (OR) = 6.63 95% CI 1.01 to 43.3) and disability score (OR = 7.19 95%CI 1.41 to 36.6). CONCLUSIONS The prevalence of LTBI in Mexican patients with RA was 14%. Our results suggest prevention of smoking and functional incapacity could reduce the risk of LTBI. Further research could endorse our results.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - José Artemio Cruz López
- Public Health Coordination, Regional Decentralized Administrative Operation Organ Veracruz-Norte, Instituto Mexicano del Seguro Social, Xalapa, MEX
| | | | - Laura González-López
- University Center of Health Sciences, Universidad de Guadalajara, Guadalajara, MEX
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Akdogan N, Dogan S, Gulseren D, Yalici-Armagan B, Ersoy-Evans S, Elcin G, Karaduman A, Atakan N. Serial Quantiferon-TB Gold test results in 279 patients with psoriasis receiving biologic therapy. Dermatol Ther 2020; 34:e14699. [PMID: 33368959 DOI: 10.1111/dth.14699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 01/19/2023]
Abstract
The risk of active tuberculosis is still a concern in patients receiving biologics. To determine the risk of latent tuberculosis infection (LTBI) reactivation by Quantiferon-TB Gold (QFT) assay in psoriatic patients treated with biologics in 11 years' follow-up, along with chest radiography alterations. This retrospective study included 279 patients with plaque-type and/or pustular, or nail psoriasis who were treated with biologics, and had results for ≥2 LTBI tests. The QFT outcomes were defined according to the baseline and the follow-up QFT results; seroconversion as from negative to positive, seroreversion as from positive to negative, persistently seronegative as invariantly negative, persistently seropositive as invariantly positive, and other any result was accepted as indeterminate. Demographic features, the presence and the type of any chest X-ray abnormality was noted during the follow-up. Of 279 baseline QFT tests, the vast majority were negative (n = 193; 69%), with a less of positive (n = 86; 31%). Ten (5.2%) of 193 patients converted from negative to positive QFT status after starting biologic therapy (P < 0.001) during 11 years' follow-up. Although these 10 patients exhibited seroconversion of QFT from negative to positive, only one patient was diagnosed with active TB. There was no statistically significant difference among biologics as regards with QFT seroconversion risk (P = .09). This study showed that 5.2% of patients showed seroconversion. Annual QFT testing remains a necessary and mandatory tool to prevent further TB reactivation in psoriasis patients taking biologic therapy although only one patient was diagnosed with active TB in this cohort.
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Affiliation(s)
- Neslihan Akdogan
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Sibel Dogan
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Duygu Gulseren
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Basak Yalici-Armagan
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Sibel Ersoy-Evans
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Gonca Elcin
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Aysen Karaduman
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
| | - Nilgun Atakan
- Hacettepe University, School of Medicine, Department of Dermatology and Venereology, Ankara, Turkey
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Megna M, Ferrillo M, Ruggiero A, Cinelli E, Gallo L, Fabbrocini G. QuantiFERON TB-gold conversion rate among psoriasis patients under biologics: a 9-year retrospective study. Int J Dermatol 2020; 60:352-357. [PMID: 32989759 DOI: 10.1111/ijd.15217] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/29/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Tuberculosis (TB) screening is mandatory for psoriasis biologic treatment. However, evidences regarding TB screening results during biologic treatment are conflicting. OBJECTIVES The aim of this study is to evaluate the rate of QuantiFERON TB Gold test (QFT) conversion in psoriasis patients during biologics over time. METHODS A 9-year single center retrospective study was performed in order to evaluate the rate of QFT conversion in patients affected by moderate-to-severe plaque psoriasis under available biological therapies (anti-TNF-α, IL-12/23, IL-17). For each patient, demographic data, age, gender, comorbidities, previous psoriasis therapy, as well as ongoing treatment type were registered. Five-hundred twenty-six patients (61.2% male, with a mean age of 52.6 ± 13.9 years) treated with biologics were enrolled. RESULTS QFT conversion occurred in 6.5% of patients over a mean treatment duration of 3.2 years. On average, QFT conversion occurred after 34.05 months of treatment. Anti-TNF-α drugs, and among them, adalimumab above all (35.5% of all cases), were the most commonly involved treatment during QFT conversion, followed by anti-IL-12/23 (17.6%) and anti-IL-17 (14.7%). However, differences among biologics class or single biologics (adalimumab, etanercept, infliximab, golimumab, certolizumab, ustekinumab, ixekizumab, secukinumab) did not approach statistical significance. CONCLUSIONS Annual TB screening is important in psoriasis patients under biologic treatment in order to avoid possible latent TB infection reactivation. Indeed, our data showed that even in a low TB prevalence country like Italy, QFT may convert over time in psoriasis patients under biologics in 6.5% of the cases.
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Affiliation(s)
- Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Maria Ferrillo
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Angelo Ruggiero
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Eleonora Cinelli
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Lucia Gallo
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Megna M, Ruggiero A, Ferrillo M, Fabbrocini G. QuantiFERON‐TB Gold conversion is not uncommon in patients with psoriasis undergoing anti‐tumour necrosis factor‐α therapy. Br J Dermatol 2020; 183:977-978. [DOI: 10.1111/bjd.19310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/28/2020] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- M. Megna
- Section of Dermatology – Department of Clinical Medicine and Surgery University of Naples Federico II 80131 Napoli Italy
| | - A. Ruggiero
- Section of Dermatology – Department of Clinical Medicine and Surgery University of Naples Federico II 80131 Napoli Italy
| | - M. Ferrillo
- Section of Dermatology – Department of Clinical Medicine and Surgery University of Naples Federico II 80131 Napoli Italy
| | - G. Fabbrocini
- Section of Dermatology – Department of Clinical Medicine and Surgery University of Naples Federico II 80131 Napoli Italy
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Sürücüoğlu S, Türel Ermertcan A, Çetinarslan T, Özkütük N. The reliability of tuberculin skin test in the diagnosis of latent tuberculosis infection in psoriasis patients: A case‐control study. Dermatol Ther 2020; 33:e13496. [DOI: 10.1111/dth.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Süheyla Sürücüoğlu
- Department of Medical Microbiology Manisa Celal Bayar University, Faculty of Medicine Manisa Turkey
| | - Aylin Türel Ermertcan
- Department of Dermatology Manisa Celal Bayar University, Faculty of Medicine Manisa Turkey
| | | | - Nuri Özkütük
- Department of Medical Microbiology Manisa Celal Bayar University, Faculty of Medicine Manisa Turkey
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Thomas K, Hadziyannis E, Hatzara C, Makris A, Tsalapaki C, Lazarini A, Klavdianou K, Antonatou K, Koutsianas C, Vassilopoulos D. Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment. Pathog Immun 2020; 5:34-51. [PMID: 32258853 PMCID: PMC7104555 DOI: 10.20411/pai.v5i1.349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 01/27/2020] [Indexed: 12/21/2022] Open
Abstract
Background: To determine the conversion and reversion rates of tuberculosis (TB) screening tests (Tuberculin Skin Test-TST, Interferon Gamma Release Assay-IGRA: T-SPOT.TB) during biologic treatment in patients with rheumatic diseases and negative baseline screening. Methods: This was a long-term, longitudinal cohort study of 50 patients with rheumatic diseases and negative baseline TB screening (TST: < 5 mm, negative T-SPOT.TB) treated with tumor necrosis factor inhibitors (TNFi) or other non-TNFi biologics. Patients were rescreened at a mean time of 1.4 (first rescreening) and 6.9 (second rescreening) years from baseline, with both assays. The conversion (negative to positive) and reversion (positive to negative) rate was calculated for each TB screening test. Results: Fifty patients (mean age = 60 years) with various rheumatic diseases (rheumatoid arthritis: n = 24, spondyloarthropathies: n = 23, other: n = 3) were enrolled. During the first phase (baseline to first rescreening), all patients were treated with TNFi while during the second phase (first to second rescreening), TNFi (54%) and non-TNFi (46%) were used. Fifteen patients (30%) displayed conversion of at least 1 screening assay during follow-up (10 at the first and 5 at the second rescreening). This conversion rate was higher with TST (n = 11, 22% or 3.47/100 patient-years) compared to T-SPOT.TB (n = 4, 8% or 1.74/100 patient-years). Among the 10 converters at the first rescreening, 5 received isoniazid (INH) preventive therapy and 5 did not; an equal number of patients (3/5, 60%) reverted to negative with or without INH therapy. None of the patients developed active TB during follow-up (6.9 ± 1.0 years). Conclusions: Approximately one-third of patients with rheumatic diseases and negative baseline TB screening developed conversion of at least 1 screening test during long-term biologic treatment. This occurred most often with TST and was usually a transient event. These findings do not support routine serial TB retesting in biologic-treated patients with rheumatic diseases in the absence of TB risk factors.
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Affiliation(s)
- Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
| | - Emilia Hadziyannis
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
| | - Chrisoula Hatzara
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
| | - Anastasia Makris
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
| | - Christina Tsalapaki
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
| | - Argyro Lazarini
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
| | - Kalliopi Klavdianou
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
| | - Katerina Antonatou
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
| | - Christos Koutsianas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
| | - Dimitrios Vassilopoulos
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece
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Wu CY, Chiu HY, Tsai TF. The seroconversion rate of QuantiFERON-TB Gold In-Tube test in psoriatic patients receiving secukinumab and ixekizumab, the anti-interleukin-17A monoclonal antibodies. PLoS One 2019; 14:e0225112. [PMID: 31881026 PMCID: PMC6934285 DOI: 10.1371/journal.pone.0225112] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 10/28/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND For psoriatic patients receiving biologics, the concern of tuberculosis (TB) infection exists. Although the TB risk of anti-interleukin (IL)-17A agents is generally considered very low, more real-world data are needed to support the safety. OBJECTIVES This study aims to provide the real-world experience of using serial QuantiFERON-TB Gold In-Tube (QFT-GIT) test among patients treated with secukinumab or ixekizumab in Taiwan, an intermediate TB burden country, for the detection of latent TB infection (LTBI) reactivation or newly acquired TB infection. METHODS This retrospective review evaluated 100 consecutive patients with psoriasis receiving anti-IL-17A therapies who were checked with at least twice QFT-GIT between 2016 and 2019 in National Taiwan University Hospital, Taipei and Hsin-Chu, Taiwan. RESULTS Among the 100 patients, the baseline QFT-GIT results were negative in 81.0% (81/100), positive in 18.0% (18/100), and indeterminate in 1.0% (1/100) of patients. The overall outcomes in patients receiving at least 6 months of cumulative exposure to anti-IL-17A agents were persistently seronegative in 80 patients (80.0%), persistently seropositive in 14 patients (14.0%), seroconversion in 1 patient (1.0%), seroreversion in 3 patients (3.0%), and others in 2 patients (2.0%). In patients with at least 11 months of cumulative exposure, the seroconversion rate was 1.3% (1/79). The only case with seroconversion had a positive QFT-GIT result previously. No case of TB reactivation or newly acquired TB infection was identified during the follow-up. CONCLUSIONS In patients treated with anti-IL-17A monoclonal antibodies for psoriasis, routine serial repeat QFT-GIT testing was associated with lower seroconversion rate compared to real-world data of tumor necrosis factor-α inhibitors and anti-IL-12/23 antibody in Taiwan and in pivotal studies. Because clinical TB symptoms and signs are often preceded by QFT-GIF seroconversion, this result further supports the safety of anti-IL-17A agents in patients with psoriasis for LTBI.
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Affiliation(s)
- Chen-Yu Wu
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Hsien-Yi Chiu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Ya J, Khanna U, Havele S, Fernandez A. Utility of repeat latent tuberculosis testing with the Quanti
FERON
‐
TB
Gold test in patients with psoriasis treated with tumour necrosis factor‐α inhibitors at a single U.S. institution. Br J Dermatol 2019; 182:800-802. [DOI: 10.1111/bjd.18461] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J. Ya
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland OH U.S.A
| | - U. Khanna
- Department of DermatologyCleveland Clinic Cleveland OH U.S.A
| | - S. Havele
- Department of Pathology Cleveland Clinic Cleveland OH U.S.A
| | - A.P. Fernandez
- Department of DermatologyCleveland Clinic Cleveland OH U.S.A
- Case Western Reserve University School of Medicine Cleveland OH U.S.A
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Hsiao CY, Chiu HY, Wang TS, Tsai TF. Serial QuantiFERON-TB Gold testing in patients with psoriasis treated with ustekinumab. PLoS One 2017; 12:e0184178. [PMID: 28886099 PMCID: PMC5590912 DOI: 10.1371/journal.pone.0184178] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 08/19/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is increasing concern about the risk of latent tuberculosis infection (LTBI) reactivation during the use of biologics for psoriasis. Although ustekinumab had been documented with low risk of tuberculosis, the long-term follow-up of LTBI as determined by QuantiFERON-TB Gold (QFT-G) testing in patients treated with ustekinumab is limited. OBJECTIVES This study aims to use serial QFT-G testing as a screening method for detecting LTBI in patients with psoriasis from an intermediate tuberculosis burden country. METHODS This retrospective review investigated 134 psoriatic patients in whom ustekinumab was prescribed for at least one year between 2010 and 2016 in National Taiwan University Hospital. All patients underwent annular QFT-G testing during ustekinumab therapy. RESULTS Among the 134 enrolled patients, baseline LTBI rate was 13.4% (18/134). Indeterminate QFT-G result was noted in 5.2% (7/134) of patients and 71.4% (5/7) of them turn to be QFT-G negative during the next testing. 81.3% (109/134) of patients had a negative QFT-G at baseline and the seroconversion rate was 7.3% (8/109) in the serial QFT-G. All the patients in the conversion group were referred to a pulmonologist for evaluation and 81.5% (22/27) of them underwent chemoprophylactic therapy while on ustekinumab. No active TB infection was noted during further follow-up with or without chemoprophylaxis. CONCLUSIONS This study revealed that psoriatic patients receiving long-term ustekinumab therapy had a low QFT-G conversion rate (7.3%). The clinical significance of QFT-G conversion remains controversial and needs larger scale trials to investigate.
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Affiliation(s)
- Chuan-Yu Hsiao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Yi Chiu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ting-Shun Wang
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Dermatology, National Taiwan University Hospital, Yun-Lin Branch, Dou-Liou, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- * E-mail:
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10
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The conversion rate of tuberculosis screening tests during biological therapies in patients with rheumatoid arthritis. Clin Rheumatol 2016; 36:457-461. [DOI: 10.1007/s10067-016-3462-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/19/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
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Muñoz L, Stagg HR, Abubakar I. Diagnosis and Management of Latent Tuberculosis Infection. Cold Spring Harb Perspect Med 2015; 5:cshperspect.a017830. [PMID: 26054858 DOI: 10.1101/cshperspect.a017830] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The post-2015 World Health Organization global tuberculosis strategy recognizes that elimination requires a focus on reducing the pool of latently infected individuals, an estimated 30% of the global population, from which future tuberculosis cases would be generated. Tackling latent tuberculosis infection requires the identification and treatment of asymptomatic individuals to reduce the risk of progression to active disease. Diagnosis of latent tuberculosis infection is based on the detection of an immune response to Mycobacterium tuberculosis antigens using either the tuberculin skin test or interferon-γ release assays. Current treatment requires the use of antibiotics for at least 3 months. In this article, we review the current knowledge of the natural history, immunology, and pathogenesis of latent tuberculosis, describe key population groups for screening and risk assessment, discuss clinical management in terms of diagnosis and preventative treatment, and identify areas for future research.
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Affiliation(s)
- Laura Muñoz
- Infectious Diseases Department, Bellvitge University Hospital-IDIBELL, Barcelona 08970, Spain Research Department of Infection and Population Health, University College London, London WC1E 6JB, United Kingdom
| | - Helen R Stagg
- Research Department of Infection and Population Health, University College London, London WC1E 6JB, United Kingdom
| | - Ibrahim Abubakar
- Research Department of Infection and Population Health, University College London, London WC1E 6JB, United Kingdom
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Gisondi P, Pezzolo E, Lo Cascio G, Girolomoni G. Latent tuberculosis infection in patients with chronic plaque psoriasis who are candidates for biological therapy. Br J Dermatol 2014; 171:884-90. [DOI: 10.1111/bjd.13130] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2014] [Indexed: 01/02/2023]
Affiliation(s)
- P. Gisondi
- Department of Medicine Section of Dermatology and Venereology University of Verona I‐37126 Verona Italy
| | - E. Pezzolo
- Department of Medicine Section of Dermatology and Venereology University of Verona I‐37126 Verona Italy
| | - G. Lo Cascio
- Department of Pathology and Diagnostics Section of Microbiology University of Verona I‐37126 Verona Italy
| | - G. Girolomoni
- Department of Medicine Section of Dermatology and Venereology University of Verona I‐37126 Verona Italy
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Sauzullo I, Scrivo R, Mengoni F, Ermocida A, Coppola M, Valesini G, Vullo V, Mastroianni CM. Multi-functional flow cytometry analysis of CD4+ T cells as an immune biomarker for latent tuberculosis status in patients treated with tumour necrosis factor (TNF) antagonists. Clin Exp Immunol 2014; 176:410-7. [PMID: 24528189 DOI: 10.1111/cei.12290] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 12/11/2022] Open
Abstract
Although monitoring tuberculosis (TB) infection during long-term treatment with tumour necrosis factor (TNF) antagonists is of great importance, no monitoring strategy has yet proved successful. Indeed, even the newly proposed interferon-gamma release assays (IGRAs) are known to produce dynamic changes in IFN-γ plasma levels, making them unreliable indicators of patients' pathological/clinical status. We used intracellular cytokine flow cytometry (ICCFC) to investigate the performance of multi-functional CD4(+) T cells producing IFN-γ, interleukin (IL)-2 and/or TNF in response to Mycobacterium tuberculosis-specific antigens in subjects treated with TNF antagonists. Patients were classified into three groups based on their TB status before commencement of treatment and on IFN-γ level fluctuations evaluated by IGRA during a 36-month follow-up period. The cytokine profile of M. tuberculosis-specific CD4(+) T cells showed that latent tuberculosis infection (LTBI) subjects had a higher frequency of double-positive IFN-γ(+) IL-2(+) CD4(+) T cells and triple-positive IFN-γ(+) IL-2(+) TNF(+) CD4(+) T cells compared to those without LTBI, who showed IFN-γ-level fluctuations over time. In contrast, this latter group of patients showed similar proportions of cells producing IFN-γ alone, IL-2 alone and IL-2 in combination with TNF in response to M. tuberculosis-specific antigens. It therefore appears that patients with and without LTBI infection are characterized by different intracellular cytokine profiles. This is the first study evaluating ICCFC in patients treated with TNF antagonists, and suggests that multi-functional analysis of CD4(+) T cells could be useful for ruling out TB infection in patients classified at screening as LTBI-negative but who show IGRA fluctuations under long-term TNF antagonist treatment.
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Affiliation(s)
- I Sauzullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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14
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SCRIVO ROSSANA, SAUZULLO ILARIA, MENGONI FABIO, PRIORI ROBERTA, COPPOLA MARIATERESA, IAIANI GIANCARLO, DI FRANCO MANUELA, VULLO VINCENZO, MASTROIANNI CLAUDIOMARIA, VALESINI GUIDO. Mycobacterial Interferon-γ Release Variations During Longterm Treatment with Tumor Necrosis Factor Blockers: Lack of Correlation with Clinical Outcome. J Rheumatol 2012. [DOI: 10.3899/jrheum.120688] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective.To assess the performance of serial QuantiFeron-TB Gold In-Tube (QFT-GIT) tests in patients with rheumatic diseases during longterm systemic treatment with biologic therapy, evaluating conversions and reversions in relation to the clinical outcome.Methods.We conducted a prospective study on patients awaiting biologic agents. At baseline, they had chest radiographs, QFT-GIT tests, and tuberculin skin tests (TST); QFT-GIT was repeated at 3, 6, 12, and 18 months after onset of biologic therapy. In patients with no evidence of latent tuberculosis infection (LTBI) at baseline, TST was repeated at 12 months of biologic treatment.Results.Among patients (n = 102; women 65.7%; median age 47 yrs, range 20–82), 14 (13.7%) were considered as having LTBI because of a minimum of 1 abnormal screening test. The agreement between QFT-GIT and TST was 88% (κ = 0.14). During biologic treatment, both patients with (n = 14) and those without (n = 88) evidence of LTBI at baseline showed conversions and reversions in QFT-GIT results at different timepoints. These fluctuations were not paralleled by significant clinical changes. The TST repeated at 12 months in patients with no evidence of LTBI at baseline continued to be negative. The median baseline interferon-γ (IFN-γ) concentration was not significantly different from that observed at each subsequent timepoint.Conclusion.Dynamic changes occur with serial IFN-γ release assay testing in patients treated with biologic therapy that do not correlate with clinical outcome. A careful and integrated evaluation of the patient, including clinical information, should guide the treatment decision. This study was underpowered for definite conclusions and further studies are needed to determine the significance of these findings.
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Domínguez J, Vilavella M, Latorre I. Interferon γ assays in the diagnosis of tuberculosis infection in psoriasis patients who are candidates for biologic therapies. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:880-6. [PMID: 23157912 DOI: 10.1016/j.adengl.2012.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 07/20/2012] [Indexed: 10/27/2022] Open
Abstract
Although there is no doubt that biologic agents are an effective alternative for the treatment of moderate and severe psoriasis, anti-tumor necrosis factor α therapy has been associated with reactivation of latent tuberculosis infection. Tuberculin skin testing (TST) is used to diagnose tuberculosis infection but it has low specificity in patients who have received the Mycobacterium bovis BCG vaccine and low sensitivity in patients with altered cell-mediated immunity. In vitro assays based on the detection of interferon γ released by T cells stimulated by specific Mycobacterium tuberculosis antigens have emerged as an option for the diagnosis of tuberculosis infection. The results to date show that they are a viable alternative to TST thanks to their higher specificity and sensitivity. Furthermore, these assays are also proving to have high negative predictive value, meaning that we might be able to use them without TST in the short to medium term.
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Affiliation(s)
- J Domínguez
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Sánchez-Moya A, García-Doval I, Carretero G, Sánchez-Carazo J, Ferrandiz C, Herrera Ceballos E, Alsina M, Ferrán M, López-Estebaranz JL, Gómez-García F, De la Cueva Dobao P, Carrascosa JM, Vanaclocha F, Belinchón I, Peral F, Dauden E. Latent tuberculosis infection and active tuberculosis in patients with psoriasis: a study on the incidence of tuberculosis and the prevalence of latent tuberculosis disease in patients with moderate-severe psoriasis in Spain. BIOBADADERM registry. J Eur Acad Dermatol Venereol 2012; 27:1366-74. [DOI: 10.1111/jdv.12011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Domínguez J, Vilavella M, Latorre I. Interferon γ Assays in the Diagnosis of Tuberculosis Infection in Psoriasis Patients Who Are Candidates for Biologic Therapies. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:880-886. [PMID: 23036486 DOI: 10.1016/j.ad.2012.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 07/17/2012] [Accepted: 07/20/2012] [Indexed: 11/19/2022] Open
Abstract
Although there is no doubt that biologic agents are an effective alternative for the treatment of moderate and severe psoriasis, anti-tumor necrosis factor α therapy has been associated with reactivation of latent tuberculosis infection. Tuberculin skin testing (TST) is used to diagnose tuberculosis infection but it has low specificity in patients who have received the Mycobacterium bovis BCG vaccine and low sensitivity in patients with altered cell-mediated immunity. In vitro assays based on the detection of interferon γ released by T cells stimulated by specific Mycobacterium tuberculosis antigens have emerged as an option for the diagnosis of tuberculosis infection. The results to date show that they are a viable alternative to TST thanks to their higher specificity and sensitivity. Furthermore, these assays are also proving to have high negative predictive value, meaning that we might be able to use them without TST in the short to medium term.
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Affiliation(s)
- J Domínguez
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, España; CIBER Enfermedades Respiratorias.
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Scrivo R, Sauzullo I, Mengoni F, Iaiani G, Vestri AR, Priori R, Di Filippo E, Di Franco M, Spinelli FR, Vullo V, Mastroianni CM, Valesini G. Serial interferon-γ release assays for screening and monitoring of tuberculosis infection during treatment with biologic agents. Clin Rheumatol 2012; 31:1567-75. [DOI: 10.1007/s10067-012-2049-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Revised: 06/20/2012] [Accepted: 07/23/2012] [Indexed: 01/19/2023]
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Balato N, Di Costanzo L, Ayala F, Balato A, Sanduzzi A, Bocchino M. Psoriatic disease and tuberculosis nowadays. Clin Dev Immunol 2012; 2012:747204. [PMID: 22645622 PMCID: PMC3356875 DOI: 10.1155/2012/747204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/21/2012] [Indexed: 01/28/2023]
Abstract
Psoriasis is a chronic, relapsing and remitting inflammatory skin and joint disease that has a prevalence of 2-3% in the world's population, whereas of 1-2% in Europe. The traditional concept of psoriasis as the "healthy people's" disease has been recently revised because of ever-increasing reports of associations with various pathological conditions (hypertension, Crohn's disease, type II diabetes mellitus, obesity, dyslipidemia, metabolic syndrome, infectious conditions). Particularly, advances in psoriasis therapies have introduced biologic agents. All the tumor necrosis factor-alpha inhibitors are associated with an increased risk of developing active disease in patients with latent tuberculosis infection, because of TNF-α key role against Mycobacterium tuberculosis. For this reason, exclusion of active tuberculosis and treatment of latent tuberculosis infection are clinical imperatives prior to starting this therapy. Moreover active surveillance for a history of untreated or partially treated tuberculosis or latent form has already been shown to be effective in reducing the number of incident tuberculosis cases.
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Affiliation(s)
- Nicola Balato
- Department of Dermatology, University of Naples Federico II, Italy
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