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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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-c) response to mitogen stimulation was impaired (median IFN-c 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 ¼ 0.0015) or 2) receiving longacting
corticosteroids (median >10.0; IQR 9.7 to >10.0; P ¼ 0.0058). Prednisolone treatment was strongly associated with negative TST,
adjusted odds ratio (AOR) 0.22 (0.1–0.8; P ¼ 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.
TidsskriftInflammatory Bowel Diseases
Udgave nummer11
Sider (fra-til)2340-2349
StatusUdgivet - 2011

Bibliografisk note

Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.

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