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The study was funded by an unrestricted grant from Abbott and Schering-Plough. The sponsor had no role in the analysis and interpretation of the data, the preparation, review, or approval of the article. Pernille Ravn holds a research grant from the Danish National Council. Conflicts of interest: Hvidovre Hospital has filed patents on the use of IP as a marker for infection with Mycobacterium tuberculosis. Morten Ruhwald and Pernille Ravn are registered as co-inventors.
Morten Ruhwald has in and received travel grants from Cellestis. This article was published online February 11, This notice is included in the online and print versions to indicate that both have been corrected March 23, A prospective multicenter study included patients with ulcerative colitis 39 , Crohn's disease 54 , rheumatoid arthritis , and spondylo-arthropathy Single use of azathioprine, methotrexate, or 5-aminosalicylate 5-ASA did not affect the test results.
Inflamm Bowel Dis ;. Tuberculosis TB is the most feared infection in these patients because of its disseminated, rapid, and aggressive manifestation with high morbidity and mortality. Patients with autoimmune diseases are often treated with immunosuppressive drugs at the time of screening for LTBI, but little is known about the influence of the individual treatment regimen on the performance of IGRA and TST.
We included patients with RD or IBD who were attending the outpatient clinics or admitted to the hospital wards during the inclusion period.
The study was a multicenter prospective cohort study with a 2-year inclusion period. Induration was recorded by an experienced examiner 48—72 hours after injection. Chest x-rays were performed in the upright position and were evaluated by experienced radiologists and the findings were classified into three groups 1 normal; 2 TB suspect apical pleural thickening, pulmonary nodules, upper lobe bronchiectasies, interstitial granulomatous calcification, and lymph node or pericardial calcification ; 3 not normal and not TB suspect i.
SAS 9. The mitogen responses were compared using a nonparametric test analysis Kruskal—Wallis test. A Fisher's exact test was used when comparing the response rates. In total, patients were recruited; eight were excluded due to missing QFT-IT results, and nine due to an uncertain diagnosis.
Of the remaining patients, [correction made here after initial online publication] had RD rheumatoid arthritis or spondylo-arthropathy , 93 IBD Crohn's disease or ulcerative colitis.
Demographic data for the patients are shown in Table 1. Treatment regimens are shown in Table 1. Of the 44 patients receiving prednisolone 16 were patients with RD and 28 with IBD [correction made here after initial online publication], and of the 32 receiving long-acting corticosteroids all were RD patients data not shown. Chest x-rays were available for patients.
No patient was diagnosed with active TB during the study period. The agreement between the tests is shown in Table 3. There is no gold standard for diagnosing LTBI and the indication for chemoprophylaxis will depend on which test or test combination is used.
In patients with RD there was no significant difference in indeterminate rate associated with overall corticosteroid use AOR 4. AOR None of the IBD patients who did not receive corticosteroids had indeterminate results, thus we could not perform regression analysis in this group. The lines represent the median values. In other studies 7. This study showed a marked negative effect of oral prednisolone treatment on the performance of the immunodiagnostic tests for LTBI.
Interestingly, this effect was alone mediated by prednisolone and not by long-acting injectable corticosteroid or any of the disease-modifying antirheumatic drugs DMARDs.
These contradictory findings are probably due to differences in study population, low sample size, variable drug regimens, different doses, or different combination of medication or because the both fast- and long-acting corticosteroids and other DMARDs were pooled in the analysis. In contrast to what has been found in previous studies, this study convincingly shows a negative effect of oral prednisolone treatment. A few reports, however, have observed an association between corticosteroid and impaired IGRA performance.
This study is one of the largest studies in patients with autoimmune disorders and the first study to show such a pronounced negative effect of prednisolone compared to other corticosteroids and other immunosuppressive drugs and drug combinations.
From our study there is no doubt that high-dose prednisolone has a detrimental effect on our screening tools for LTBI but the extent to which low-dose prednisolone affects these tests may be even more relevant. The findings by Kleinert et al 31 and Ponce de Leon et al suggest that 7. Although the negative effect is most pronounced during high-dose treatment, doses in the range of 5—10 mg do appear to be associated with impaired test responses; however, more studies in this low-dose area are needed.
Interestingly, we found no negative effect of long-acting corticosteroid injections. Reasons for this could be differences in potency, or the fact that the long-acting corticosteroids had been administered up to 12 weeks prior to the immunodiagnostic tests for LTBI. A decline in effective drug concentration over time could be an explanation. Compartmentalization where the drug exerts its effect locally rather than on the circulating T cells is another potential explanation. It is well known that corticosteroids increase the risk of TB 35 and have a suppressive effect on T-cell responsiveness, 36 which may result in a negative effect on the performance of the immunodiagnostic tests for LTBI.
A test for immunosuppression that could identify patients at risk of false-negative and inconclusive test results would be useful.
In HIV patients, as an example, a low CD4 cell count is strongly associated with low sensitivity and more indeterminate results. A more sensitive test would solve the problem with indeterminate and false-negative results. The sequence of testing and the methods used are debated and national guidelines differ. The IGRA test is replacing TST as the screening instrument in Denmark and many other countries due to a better sensitivity and specificity, more objective readout, and no need for a second visit.
The role of each method, however, is not validated; chest x-ray is neither sufficiently sensitive nor specific for diagnosing LTBI and is mainly used to rule out active pulmonary TB.
Given the work load and the radiation associated with chest x-ray, an evaluation of the actual benefits within this screening program should be performed.
Finally, we do not yet know which test or combination of tests can prevent most cases and reduce the numbers needed to treat. Prospective randomized interventional trials based on IGRAs would be unethical and we must rely on observational studies and thorough reporting of cases of TB that were not prevented despite the current screening procedures.
Our study has several strengths, such as the large sample size of patients in each treatment group, which enabled us to demonstrate an association with specific treatment regimes and test outcomes. However, there are some limitations; the study was set up in a low endemic country with an overall low prevalence of active as well as latent TB infection and the data are not directly applicable to TB high endemic countries.
We did not have sufficient power to assess the association between QFT-IT sensitivity and corticosteroid treatment due to a low number of latently infected individuals in Denmark.
It is likely, however, that the Mtb-specific antigen response may be affected by prednisolone as well as the PHA response, resulting in lower test sensitivity, but studies in meso- and high-endemic regions will be needed to answer this question. As the study was not designed as a follow-up study, we could not assess the predictive value of QFT-IT, TST, or the effect of other screening and interventions.
Finally, our study may not have had sufficient power to demonstrate a negative effect of long-acting steroids because injections had been given over a wide time span from 1—12 weeks before testing. However, we found only one indeterminate case among the 32 patients receiving long-acting steroids, suggesting that there is no negative effect of long-acting corticosteroids.
We suggest that patients should be screened for LTBI before initiation of prednisolone treatment, or that prednisolone should be paused, if possible, before screening.
Furthermore, we suggest that a negative QFT-IT or TST result should be interpreted with caution in patients who are treated with any corticosteroid until our findings have been confirmed. There is a need for studies that can confirm that long-acting corticosteroids have no negative effect on QFT-IT and TST performance and a study of the effect low of dose prednisolone in the range of 2. Finally, the use of x-ray and risk factor analysis need to be further validated.
We thank nurse Carina Blixt for helping to organize the study and include patients. We thank Vibeke O. We thank all the study subjects for their participation. In Table 1 missing data in the Prednisolone and Long acting corticosteroid rows have been added and percentages have been changed for inconsistent rounding.
Table 4 has been corrected for wrong numbers in the some of the fractions and minor typos. The changes have not influenced the findings or conclusions of the paper. Evaluation of latent tuberculosis infection in patients with inflammatory arthropathies before treatment with TNF-alpha blocking drugs using a novel flow-cytometric interferon-gamma release assay.
Rheumatology Oxford. Semin Arthritis Rheum. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. Wallis RS. Infectious complications of tumor necrosis factor blockade. Curr Opin Infect Dis. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials.
Antirheumatic drugs and the risk of tuberculosis. Clin Infect Dis. Rev Port Pneumol. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report.
Arthritis Rheum. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. Keane J. TNF-blocking agents and tuberculosis: new drugs illuminate an old topic.
Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy: The three-year prospective French Research Axed on Tolerance of Biotherapies registry. Larger studies are needed to verify our results.
You will be able to get a quick price and instant permission to reuse the content in many different ways. Skip to main content. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts. Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword.
Advanced search. Log in via Institution. Email alerts. Article Text. Article menu. Poster Presentations. Reitblat 1 , T. Lerman 1 , O.
❾-50%}Tb test prednisone. Targeted TB Testing & Interpreting Skin Test Results
Antirheumatic drugs and the risk of tuberculosis. Clin Infect Dis. Rev Port Pneumol. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report. Arthritis Rheum. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. Keane J.
TNF-blocking agents and tuberculosis: new drugs illuminate an old topic. Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy: The three-year prospective French Research Axed on Tolerance of Biotherapies registry.
Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Prevention of opportunistic infections in patients with inflammatory bowel disease and implications of the ECCO consensus in Belgium.
Acta Gastroenterol Belg. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment. Eur Respir J. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. Comparison of two interferon-gamma assays and tuberculin skin test for tracing tuberculosis contacts. Performance of two commercial blood IFN-gamma release assays for the detection of Mycobacterium tuberculosis infection in patient candidates for anti-TNF-alpha treatment.
Comparison of tuberculin skin test and new specific blood test in tuberculosis contacts. Predictive value of a whole blood IFN-gamma assay for the development of active tuberculosis disease after recent infection with Mycobacterium tuberculosis.
Routine hospital use of a new commercial whole blood interferon-gamma assay for the diagnosis of tuberculosis infection. Performance of the tuberculin skin test and interferon-gamma release assay for detection of tuberculosis infection in immunocompromised patients in a BCG-vaccinated population.
BMC Infect Dis. Detection of latent tuberculosis in immunosuppressed patients with autoimmune diseases performance of a mycobacterium tuberculosis antigen specific IFN-gamma assay.
Ann Rheum Dis. Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med. Attenuated response to purified protein derivative in patients with rheumatoid arthritis: study in a population with a high prevalence of tuberculosis.
Comparison of an interferon-gamma assay with tuberculin skin testing for detection of tuberculosis TB infection in patients with rheumatoid arthritis in a TB-endemic population.
J Rheumatol. Detecting a low prevalence of latent tuberculosis among health care workers in Denmark detected by M. Scand J Infect Dis. Comparison of screening procedures for Mycobacterium tuberculosis infection among patients with inflammatory diseases.
Comparison of interferon-gamma release assay versus tuberculin skin test for tuberculosis screening in inflammatory bowel disease. Am J Gastroenterol. Glucocorticoid use, other associated factors, and the risk of tuberculosis. The effects of cytokines on suppression of lymphocyte proliferation by dexamethasone. J Immunol. The impact of HIV infection and CD4 cell count on the performance of an interferon gamma release assay in patients with pulmonary tuberculosis.
PLoS One. Detection and prediction of active tuberculosis disease by a whole-blood interferon-gamma release assay in HIVinfected individuals. Latent tuberculosis in HIV positive, diagnosed by the M. Respir Res. Reducing tuberculosis incidence by tuberculin skin testing, preventive treatment, and antiretroviral therapy in an area of low tuberculosis transmission. Chemokine IP an adjunct marker for latent tuberculosis infection in children.
Int J Tuberc Lung Dis. Ruhwald M , Ravn P. Biomarkers of latent TB infection. Expert Rev Respir Med. Improving T-cell assays for the diagnosis of latent TB infection: potential of a diagnostic test based on IP Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
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Close mobile search navigation Article Navigation. Volume Article Contents Patients and Methods. There was no significant difference in mean TST between these three groups 5. Therefore, we conclude that the criterion of 5 mm TST reaction defining latent TB infection in our population should be re-evaluated. Larger studies are needed to verify our results. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Skip to main content. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts. Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword. Statistical analysis was performed using SPSS Chi-square test was used to test the hypothesis about equality of proportion between the groups.
A total number of patients, found eligible for the study, were invited to participate in the study from August to March Only patients consented out of which six patients did not turn up for TST reading after 72 hours and were thus excluded making the total number of participants in the study Primarily the patients were middle aged None of the patients had undergone a TST within last two years.
Demographic profile of different groups of patients based on methotrexate dose is given in Table 1. Though tuberculin positivity was not affected by MTX intake in patients Table 3 , it was significantly lower in patients with recent steroid intake Group I , as compared to patients without any steroid intake within 3 months control S. There was no significant difference between control S and group II Table 4.
A prospective study of serial tuberculin skin testing performed on patients from the chronic care wards of a Veterans Administration Hospital revealed a positive test in In a study in Taiwan, From India, Seal et al. In our study, The study was done at a single centre in North India and may need to be replicated on multicentric study. Comparing the results from our study with the available population data, we can infer that presence of rheumatoid arthritis influences the results of tuberculin test in our population.
In a study from Italy also, prevalence of latent tuberculosis using TST, among patients suffering from immunomediated inflammatory diseases, was found to be Lower rates of TST positivity in RA may be attributable to the disease itself or the drugs used for its therapy.
Another suggestion from this study was that there is no effect of MTX dose on the results of tuberculin test. However, even the low doses of recent steroid intake significantly reduce the chances of tuberculin positivity.
These results echo the results from the past studies. A study carried out at Florence, Italy, revealed that the proportion of positive scoring for TST was significantly lower in patients on treatment with steroids compared with the proportion of positive results in patients who were not receiving treatment with steroids. Schatz et al. However, it is not statistically significant due to small number of patients but should be explored further in view of its clinical importance.
In this study, consecutive patients with RA, fulfilling the inclusion criteria, were enrolled from the outpatient department and then grouped according to their therapy. This led to disproportionate groups which is a limitation of the study. Another limitation of the study is that patients were on different forms and doses of different corticosteroids. Long acting immunosuppression may have affected results in some patients. This intermediate degree of TST positivity in group exposed to steroids in last 3 months but not in last 1 week could be because of differing magnitude and duration of immunosuppressive effect of different forms of steroids taken by the patients.
In such a situation TST cannot be relied upon for screening of latent tuberculosis. Our study suggests that steroid intake within the last 1 week significantly lowers the chances of tuberculin positivity.
Therefore in patients with RA, before administration of biologicals, tuberculin test should be read with caution if there is history of recent steroid intake.
The authors declare that there is no conflict of interests regarding the publication of this paper. Slot, P. Deville, N. Hill, B. Williams, and M. Bahr, G. Rook, M. Al-Saffar, J. Stanford, and K. Yamada, A. Nakajima, E. Inoue et al. Wolfe, K. Michaud, J. Anderson, and K. Askling, C. Fored, L. Brandt et al. Carmona, C.
Background Reactivation of latent tuberculosis TB is a major complication of tumor necrosis factor alpha inhibitors TNF-i. Therefore, screening for latent TB is recommended before initiation of this treatment.
Currently, the cut-off size of a positive Tuberculosis skin test TST among immunosuppressed patients is 5 mm. It is vastly described in the literature that Prednisone treatment along with chronic inflammatory disease depresses TST reaction. Nevertheless, few studies reject this hypothesis. TST measurements, Prednisone and Methotrexate doses and treatment durations were recorded.
Active tuberculosis TB was excluded by chest X-ray and patient's history. A control group, was randomly selected from healthy patients who had a TST at the pulmonology clinic in our institution. We compared the results of the mean TST reaction size between the following three groups: RA patients with current prednisone treatment, RA patients without history of prednisone treatment and healthy individuals. A correlation between this score and the size of the TST reaction was assessed using Pearson's correlation coefficient r.
Results 43 mean age There was no significant difference in mean TST between these three groups 5. Therefore, we conclude that the criterion of 5 mm TST reaction defining latent TB infection in our population should be re-evaluated. Larger studies are needed to verify our results. You will be able to get a quick price and instant permission to reuse the content in many different ways. Skip to main content. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts.
Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword. Advanced search. Log in via Institution. Email alerts. Article Text. Article menu. Poster Presentations. Reitblat 1T. Lerman 1O. Cohen 2T. Disclosure of Interest None declared. Statistics from Altmetric. Read the full text or download the PDF:. Log in.
Currently, the cut-off size of a positive Tuberculosis skin test (TST) among immunosuppressed patients is 5 mm. It is vastly described in the literature that. Prednisolone treatment does affect the performance of the QuantiFERON in-tube test and the tuberculin skin test in patients with autoimmune disorders screened. Corticosteroids have been used to support the treatment of serious and severe consequences of TB, such as miliary TB, respiratory insufficiency. The Mantoux tuberculin skin test (TST) is the The skin test reaction should be read between 48 day of prednisone for 1 month or. old TB; Organ transplant recipients; Persons who are immunosuppressed for other reasons (e.g., taking the equivalent of >15 mg/day of prednisone for 1. Hill, B. A total number of patients, found eligible for the study, were invited to participate in the study from August to March Results A total number of patients, found eligible for the study, were invited to participate in the study from August to March The agreement between the tests is shown in Table 3. Abstract Tuberculin skin test has been used as an indicator of latent tuberculosis in patients with Rheumatoid Arthritis RA before administration of biologicals. Fifty-oneThe study was funded by an unrestricted grant from Abbott and Schering-Plough. The sponsor had no role in the analysis and interpretation of the data, the preparation, review, or approval of the article. Pernille Ravn holds a research grant from the Danish National Council. Conflicts of interest: Hvidovre Hospital has filed patents on the use of IP as a marker for infection with Mycobacterium tuberculosis. Morten Ruhwald and Pernille Ravn are registered as co-inventors.
Morten Ruhwald has in and received travel grants from Cellestis. This article was published online February 11, This notice is included in the online and print versions to indicate that both have been corrected March 23, A prospective multicenter study included patients with ulcerative colitis 39 , Crohn's disease 54 , rheumatoid arthritis , and spondylo-arthropathy Single use of azathioprine, methotrexate, or 5-aminosalicylate 5-ASA did not affect the test results.
Inflamm Bowel Dis ;. Tuberculosis TB is the most feared infection in these patients because of its disseminated, rapid, and aggressive manifestation with high morbidity and mortality. Patients with autoimmune diseases are often treated with immunosuppressive drugs at the time of screening for LTBI, but little is known about the influence of the individual treatment regimen on the performance of IGRA and TST.
We included patients with RD or IBD who were attending the outpatient clinics or admitted to the hospital wards during the inclusion period. The study was a multicenter prospective cohort study with a 2-year inclusion period.
Induration was recorded by an experienced examiner 48—72 hours after injection. Chest x-rays were performed in the upright position and were evaluated by experienced radiologists and the findings were classified into three groups 1 normal; 2 TB suspect apical pleural thickening, pulmonary nodules, upper lobe bronchiectasies, interstitial granulomatous calcification, and lymph node or pericardial calcification ; 3 not normal and not TB suspect i.
SAS 9. The mitogen responses were compared using a nonparametric test analysis Kruskal—Wallis test. A Fisher's exact test was used when comparing the response rates. In total, patients were recruited; eight were excluded due to missing QFT-IT results, and nine due to an uncertain diagnosis. Of the remaining patients, [correction made here after initial online publication] had RD rheumatoid arthritis or spondylo-arthropathy , 93 IBD Crohn's disease or ulcerative colitis.
Demographic data for the patients are shown in Table 1. Treatment regimens are shown in Table 1. Of the 44 patients receiving prednisolone 16 were patients with RD and 28 with IBD [correction made here after initial online publication], and of the 32 receiving long-acting corticosteroids all were RD patients data not shown. Chest x-rays were available for patients. No patient was diagnosed with active TB during the study period. The agreement between the tests is shown in Table 3.
There is no gold standard for diagnosing LTBI and the indication for chemoprophylaxis will depend on which test or test combination is used. In patients with RD there was no significant difference in indeterminate rate associated with overall corticosteroid use AOR 4. AOR None of the IBD patients who did not receive corticosteroids had indeterminate results, thus we could not perform regression analysis in this group. The lines represent the median values. In other studies 7.
This study showed a marked negative effect of oral prednisolone treatment on the performance of the immunodiagnostic tests for LTBI. Interestingly, this effect was alone mediated by prednisolone and not by long-acting injectable corticosteroid or any of the disease-modifying antirheumatic drugs DMARDs. These contradictory findings are probably due to differences in study population, low sample size, variable drug regimens, different doses, or different combination of medication or because the both fast- and long-acting corticosteroids and other DMARDs were pooled in the analysis.
In contrast to what has been found in previous studies, this study convincingly shows a negative effect of oral prednisolone treatment. A few reports, however, have observed an association between corticosteroid and impaired IGRA performance.
This study is one of the largest studies in patients with autoimmune disorders and the first study to show such a pronounced negative effect of prednisolone compared to other corticosteroids and other immunosuppressive drugs and drug combinations.
From our study there is no doubt that high-dose prednisolone has a detrimental effect on our screening tools for LTBI but the extent to which low-dose prednisolone affects these tests may be even more relevant. The findings by Kleinert et al 31 and Ponce de Leon et al suggest that 7. Although the negative effect is most pronounced during high-dose treatment, doses in the range of 5—10 mg do appear to be associated with impaired test responses; however, more studies in this low-dose area are needed.
Interestingly, we found no negative effect of long-acting corticosteroid injections. Reasons for this could be differences in potency, or the fact that the long-acting corticosteroids had been administered up to 12 weeks prior to the immunodiagnostic tests for LTBI.
A decline in effective drug concentration over time could be an explanation. Compartmentalization where the drug exerts its effect locally rather than on the circulating T cells is another potential explanation. It is well known that corticosteroids increase the risk of TB 35 and have a suppressive effect on T-cell responsiveness, 36 which may result in a negative effect on the performance of the immunodiagnostic tests for LTBI.
A test for immunosuppression that could identify patients at risk of false-negative and inconclusive test results would be useful. In HIV patients, as an example, a low CD4 cell count is strongly associated with low sensitivity and more indeterminate results.
A more sensitive test would solve the problem with indeterminate and false-negative results. The sequence of testing and the methods used are debated and national guidelines differ.
The IGRA test is replacing TST as the screening instrument in Denmark and many other countries due to a better sensitivity and specificity, more objective readout, and no need for a second visit. The role of each method, however, is not validated; chest x-ray is neither sufficiently sensitive nor specific for diagnosing LTBI and is mainly used to rule out active pulmonary TB.
Given the work load and the radiation associated with chest x-ray, an evaluation of the actual benefits within this screening program should be performed. Finally, we do not yet know which test or combination of tests can prevent most cases and reduce the numbers needed to treat. Prospective randomized interventional trials based on IGRAs would be unethical and we must rely on observational studies and thorough reporting of cases of TB that were not prevented despite the current screening procedures.
Our study has several strengths, such as the large sample size of patients in each treatment group, which enabled us to demonstrate an association with specific treatment regimes and test outcomes. However, there are some limitations; the study was set up in a low endemic country with an overall low prevalence of active as well as latent TB infection and the data are not directly applicable to TB high endemic countries.
We did not have sufficient power to assess the association between QFT-IT sensitivity and corticosteroid treatment due to a low number of latently infected individuals in Denmark. It is likely, however, that the Mtb-specific antigen response may be affected by prednisolone as well as the PHA response, resulting in lower test sensitivity, but studies in meso- and high-endemic regions will be needed to answer this question. As the study was not designed as a follow-up study, we could not assess the predictive value of QFT-IT, TST, or the effect of other screening and interventions.
Finally, our study may not have had sufficient power to demonstrate a negative effect of long-acting steroids because injections had been given over a wide time span from 1—12 weeks before testing. However, we found only one indeterminate case among the 32 patients receiving long-acting steroids, suggesting that there is no negative effect of long-acting corticosteroids.
We suggest that patients should be screened for LTBI before initiation of prednisolone treatment, or that prednisolone should be paused, if possible, before screening. Furthermore, we suggest that a negative QFT-IT or TST result should be interpreted with caution in patients who are treated with any corticosteroid until our findings have been confirmed.
There is a need for studies that can confirm that long-acting corticosteroids have no negative effect on QFT-IT and TST performance and a study of the effect low of dose prednisolone in the range of 2. Finally, the use of x-ray and risk factor analysis need to be further validated.
We thank nurse Carina Blixt for helping to organize the study and include patients. We thank Vibeke O. We thank all the study subjects for their participation. In Table 1 missing data in the Prednisolone and Long acting corticosteroid rows have been added and percentages have been changed for inconsistent rounding.
Table 4 has been corrected for wrong numbers in the some of the fractions and minor typos. The changes have not influenced the findings or conclusions of the paper. Evaluation of latent tuberculosis infection in patients with inflammatory arthropathies before treatment with TNF-alpha blocking drugs using a novel flow-cytometric interferon-gamma release assay. Rheumatology Oxford. Semin Arthritis Rheum. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study.
Infliximab for induction and maintenance therapy for ulcerative colitis. N Engl J Med. Wallis RS. Infectious complications of tumor necrosis factor blockade. Curr Opin Infect Dis. Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials.
Antirheumatic drugs and the risk of tuberculosis. Clin Infect Dis. Rev Port Pneumol. Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to significant increase in tuberculosis risk: a multicenter active-surveillance report.
Arthritis Rheum. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. Keane J. TNF-blocking agents and tuberculosis: new drugs illuminate an old topic. Risk of tuberculosis is higher with anti-tumor necrosis factor monoclonal antibody therapy than with soluble tumor necrosis factor receptor therapy: The three-year prospective French Research Axed on Tolerance of Biotherapies registry. Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists.
Prevention of opportunistic infections in patients with inflammatory bowel disease and implications of the ECCO consensus in Belgium. Acta Gastroenterol Belg. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-alpha treatment.
Eur Respir J. Targeted tuberculin testing and treatment of latent tuberculosis infection.
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