Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection
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Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection. / Bélard, Erika; Semb, Synne; Ruhwald, Morten; Werlinrud, Anne Marie; Soborg, Bolette; Jensen, Frank Krieger; Thomsen, Henrik; Brylov, Annette; Hetland, Merete Lund; Nordgaard-Lassen, Inge; Ravn, Pernille; Thomsen, Henrik Segelcke; Hetland, Merete Lund.
I: Inflammatory Bowel Diseases, Bind 17, Nr. 11, 2011, s. 2340-2349.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Prednisolone treatment affects the performance of the QuantiFERON gold in-tube test and the tuberculin skin test in patients with autoimmune disorders screened for latent tuberculosis infection
AU - Bélard, Erika
AU - Semb, Synne
AU - Ruhwald, Morten
AU - Werlinrud, Anne Marie
AU - Soborg, Bolette
AU - Jensen, Frank Krieger
AU - Thomsen, Henrik
AU - Brylov, Annette
AU - Hetland, Merete Lund
AU - Nordgaard-Lassen, Inge
AU - Ravn, Pernille
AU - Thomsen, Henrik Segelcke
AU - Hetland, Merete Lund
N1 - Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.
PY - 2011
Y1 - 2011
N2 - BACKGROUND: During screening for latent tuberculosis infection (LTBI), before anti-tumor-necrosis-factor-a treatment, most patients are already receiving immunosuppressive therapy. The objective was to evaluate the performance of the QuantiFERON Gold In-Tube (QFT-IT) and the Tuberculin Skin Test (TST). METHODS: A prospective multicenter study included 248 patients with ulcerative colitis (39), Crohn's disease (54), rheumatoid arthritis (111), and spondylo-arthropathy (44). 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 for tuberculosis in 5/236 (2%), and 35/167 (21%) had =1 risk-factors for infection with Mycobacterium tuberculosis. The main finding was a pronounced negative effect on QFT-IT and TST performance associated with prednisolone treatment. During prednisolone treatment interferon gamma (IFN-¿) response to mitogen stimulation was impaired (median IFN-¿ response 4.9 IU/mL; interquartile range [IQR] 0.8 to =10.0) compared to patients 1) not receiving corticosteroids (median =10.0; IQR 5.0 to =10.0; P = 0.0015) or 2) receiving long-acting corticosteroids (median >10.0; IQR 9.7 to >10.0; P = 0.0058). Prednisolone treatment was strongly associated with negative TST, adjusted odds ratio (AOR) 0.22 (0.1-0.8; P = 0.018), and with an increased risk of indeterminate QFT-IT results AOR 16.1 (4.1-63.2; P < 0.001), whereas no negative effect was found for long-acting corticosteroids. Doses of =10 mg prednisolone were associated with a 27% risk of indeterminate results. Single use of azathioprine, methotrexate, or 5-aminosalicylate (5-ASA) did not affect the test results. CONCLUSIONS: Oral prednisolone severely suppressed QFT-IT and TST performance, whereas the long-acting corticosteroids methotrexate, azathioprine, and 5-ASA did not have a similar detrimental effect. Patients should be screened for LTBI with QFT-IT or TST prior to initiation of prednisolone therapy and negative QFT-IT or TST results interpreted with caution in patients treated with any corticosteroid until further data are available. (Inflamm Bowel Dis 2011).
AB - BACKGROUND: During screening for latent tuberculosis infection (LTBI), before anti-tumor-necrosis-factor-a treatment, most patients are already receiving immunosuppressive therapy. The objective was to evaluate the performance of the QuantiFERON Gold In-Tube (QFT-IT) and the Tuberculin Skin Test (TST). METHODS: A prospective multicenter study included 248 patients with ulcerative colitis (39), Crohn's disease (54), rheumatoid arthritis (111), and spondylo-arthropathy (44). 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 for tuberculosis in 5/236 (2%), and 35/167 (21%) had =1 risk-factors for infection with Mycobacterium tuberculosis. The main finding was a pronounced negative effect on QFT-IT and TST performance associated with prednisolone treatment. During prednisolone treatment interferon gamma (IFN-¿) response to mitogen stimulation was impaired (median IFN-¿ response 4.9 IU/mL; interquartile range [IQR] 0.8 to =10.0) compared to patients 1) not receiving corticosteroids (median =10.0; IQR 5.0 to =10.0; P = 0.0015) or 2) receiving long-acting corticosteroids (median >10.0; IQR 9.7 to >10.0; P = 0.0058). Prednisolone treatment was strongly associated with negative TST, adjusted odds ratio (AOR) 0.22 (0.1-0.8; P = 0.018), and with an increased risk of indeterminate QFT-IT results AOR 16.1 (4.1-63.2; P < 0.001), whereas no negative effect was found for long-acting corticosteroids. Doses of =10 mg prednisolone were associated with a 27% risk of indeterminate results. Single use of azathioprine, methotrexate, or 5-aminosalicylate (5-ASA) did not affect the test results. CONCLUSIONS: Oral prednisolone severely suppressed QFT-IT and TST performance, whereas the long-acting corticosteroids methotrexate, azathioprine, and 5-ASA did not have a similar detrimental effect. Patients should be screened for LTBI with QFT-IT or TST prior to initiation of prednisolone therapy and negative QFT-IT or TST results interpreted with caution in patients treated with any corticosteroid until further data are available. (Inflamm Bowel Dis 2011).
U2 - 10.1002/ibd.21605
DO - 10.1002/ibd.21605
M3 - Journal article
C2 - 21319275
VL - 17
SP - 2340
EP - 2349
JO - Inflammatory Bowel Diseases
JF - Inflammatory Bowel Diseases
SN - 1078-0998
IS - 11
ER -
ID: 34049326