RT Journal Article
SR Electronic
T1 Prednisolone treatment does affect the performance of the QuantiFERON in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 4900
VO 38
IS Suppl 55
A1 Erika Belard
A1 Synne Semb
A1 Morten Ruhwald
A1 Anne Marie Werlinrud
A1 Bolette Søborg
A1 Frank Kriger Jensen
A1 Henrik Thomsen
A1 Annette Brylov
A1 Merete Lund Hetland
A1 Inge Nordgaard-Lasen
A1 Inge Nordgaard-Lasen
A1 Pernille Ravn
YR 2011
UL http://erj.ersjournals.com/content/38/Suppl_55/4900.abstract
AB Background: During screening for latent tuberculosis infection (LTBI), before anti-TNF-alpha treatment, most patients are already receiving immunosuppressive therapy. Objective was to evaluate the performance of the QuantiFERON In-Tube (QFT-IT) and the Tuberculin Skin Test (TST) in these groupsMethods: We included 248 patients with Ulcerative Colitis, Crohns disease, rheumatoid arthritis, and spondylo-arthropathy.Results: QFT-IT was positive in 7/248 (3%), negative in 229 (92%), and indeterminate in 12 (5%). TST was positive in 54/238 (23%) patients. Chest X-ray was suspect in 5/236 (2%), and 35/167 (21%) had risk-factors.We found a pronounced negative effect on QFT-IT and TST performance associated with prednisolone treatment; the IFN- response to mitogen stimulation was impaired (median IFN- response 4.9IU/ml (IQR0.8-10.0)) compared to patients a) not receiving corticosteroids (median 10.0 (IQR 5.0-10.0) (p=0.0015) or b) receiving long-acting corticosteroids (median 10.0 (IQR 9.7-10.0) (p=0.0058).Prednisolone treatment was strongly associated with negative TST, AOR 0.22 (0.1-0.8 (p= 0.018), and with an increased risk of indeterminate QFT-IT results AOR (16.1-69.0) p=0.001). No negative effect was found for long-acting corticosteroids. Prednisolon doses above 10 mgresulted in 27% indeterminate results.Conclusion: Oral prednisolone severely suppressed QFT-IT and TST performance whereas long-acting corticosteoroids, Metotrexate, Azathioprin and 5-ASA did not have similar detrimental effect. Patients should be screened for LTBI with QFT-IT or TST prior to initiation of prednisolone.