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Serial Tuberculin Skin Tests Improve the Detection of Latent Tuberculosis Infection in Patients With Inflammatory Bowel Disease

2018; Oxford University Press; Volume: 12; Issue: 11 Linguagem: Inglês

10.1093/ecco-jcc/jjy104

1876-4479

Carlos Taxonera, Ángel Ponferrada, Sabino Riestra, Fernando Bermejo, Cristina Saro, María Dolores Martín‐Arranz, José Luis Cabriada, Manuel Barreiro‐de Acosta, María Luisa de Castro, Pilar López Serrano, Jesús Barrio, Cristina Suárez-Mejías, Eva Iglesias, Federico Argüelles‐Arias, Isabel Ferrer, Ignacio Marín‐Jiménez, Alejandro Hernández-Camba, Guillermo Bastida, Manuel Van Domselaar, Pilar Martínez-Montiel, David Olivares, Montserrat Rivero, Luís Fernández-Salazar, Óscar Nantes, Olga Merino, Cristina Alba, Javier P. Gisbert, M D M Martín-Rodríguez, Belén Botella, Daniel Carpio, Daniel Ceballos, Cristina Verdejo, Ignacio Morales, Jesús Legido, M. Peñate, María Chaparro, Alicia Algaba, Ruth de Francisco,

Infectious Diseases and Tuberculosis

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.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.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].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.