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Serial Tuberculin Skin Tests Improve the Detection of Latent Tuberculosis Infection in Patients With Inflammatory Bowel Disease
- Source :
- Journal of Crohn's and Colitis. 12:1270-1279
- Publication Year :
- 2018
- Publisher :
- Oxford University Press (OUP), 2018.
-
Abstract
- Aim To assess the likelihood of detecting latent tuberculosis infection [LTBI] by the positive conversion of a serial tuberculin skin test [TST] at 1 year in inflammatory bowel disease [IBD] patients with negative baseline two-step TST. Methods In this multicentre prospective cohort study, we evaluated rate and predictors of conversion of TST at 1 year in patients with negative baseline TST. We also evaluated management of patients who had a positive TST at baseline or a conversion at 1 year. In all patients we assessed TB cases occurring during follow-up. Results Of the 192 IBD patients receiving anti-tumour necrosis factor [TNF] and 220 IBD controls not receiving anti-TNF, 35 [8.5%, 95% CI 5.7-11.3] had positive conversion (median TST induration 13 mm, interquartile range [IQR] 9-16). Ten anti-TNF cohort patients [5.2%, 95% CI 2.5-9.5] versus 25 controls [11.4%, 95% CI 7.5-16.3] had TST conversion [p = 0.029]. In multivariate analysis, conversion was associated with smoking habit (odds ratio [OR] 2.19, 95% CI 1.08-3.97; p = 0.028). Anti-TNF-treated patients had a lower conversion rate [OR 0.41, 95% CI 0.20-0.83; p = 0.013]. The likelihood of conversion correlates with fewer immunosuppressive therapies between baseline TST and TST at 1 year [p = 0.042]. One case of active TB [isoniazid-resistant strain] occurred in a patient with positive baseline TST receiving anti-TNF [0.05 events/100 patient-years]. Conclusions Serial TST at 1 year can detect LTBI in IBD patients receiving anti-TNF therapy with negative baseline TST. Serial TST seems to be advisable to reduce the risk of TB cases associated with inability to detect LTBI in pre-treatment screening.
- Subjects :
- Adult
Male
medicine.medical_specialty
Tuberculosis
Antitubercular Agents
Tuberculin
03 medical and health sciences
0302 clinical medicine
Gastrointestinal Agents
Adrenal Cortex Hormones
Latent Tuberculosis
Interquartile range
Internal medicine
medicine
Humans
Prospective Studies
Prospective cohort study
Skin Tests
030203 arthritis & rheumatology
Gastrointestinal agent
Latent tuberculosis
Tumor Necrosis Factor-alpha
business.industry
Smoking
Adalimumab
Gastroenterology
Antibodies, Monoclonal
General Medicine
Odds ratio
Middle Aged
Inflammatory Bowel Diseases
bacterial infections and mycoses
medicine.disease
Infliximab
Seroconversion
Cohort
Female
030211 gastroenterology & hepatology
business
Immunosuppressive Agents
Subjects
Details
- ISSN :
- 18764479 and 18739946
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- Journal of Crohn's and Colitis
- Accession number :
- edsair.doi.dedup.....494cc14967d648275c6763abef805bdf