Comparison of latent tuberculosis infection screening strategies before tumor necrosis factor inhibitor treatment in inflammatory arthritis: IGRA-alone versus combination of TST and IGRA

Dae Hyun Jeong; Jieun Kang; Young Ju Jung; Bin Yoo; Chang-Keun Lee; Yong-Gil Kim; Seokchan Hong; Tae Sun Shim; Kyung-Wook Jo

doi:10.1371/journal.pone.0198756

Comparison of latent tuberculosis infection screening strategies before tumor necrosis factor inhibitor treatment in inflammatory arthritis: IGRA-alone versus combination of TST and IGRA

PLoS One. 2018 Jul 5;13(7):e0198756. doi: 10.1371/journal.pone.0198756. eCollection 2018.

Authors

Dae Hyun Jeong¹, Jieun Kang¹, Young Ju Jung¹, Bin Yoo², Chang-Keun Lee², Yong-Gil Kim², Seokchan Hong², Tae Sun Shim¹, Kyung-Wook Jo¹

Affiliations

¹ Division of Pulmonology and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
² Department of Rheumatology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.

Abstract

This study aims to compare the latent tuberculosis infection (LTBI) screening strategy of interferon-gamma release assay (IGRA)-alone and in combination with tuberculin skin tests (TSTs) before the initiation of tumor necrosis factor (TNF) inhibitor treatment in patients with inflammatory arthritis. Between January 2011 and June 2017, we enrolled 476 patients who were followed up for ≥1 year after the TNF inhibitor initiation in a tertiary referral center in South Korea. Inflammatory arthritis comprised rheumatoid arthritis in 266 (55.9%) and ankylosing spondylitis in 210 (44.1%) patients. The following strategies were used for LTBI screening during the study period: (i) from January 2011 to October 2014, the combination of TST and QuantiFERON-TB Gold In-Tube (QFT-GIT); (ii) between November 2014 and February 2015, QFT-GIT-alone and (iii) since March 2015, either the combination of TST and QFT-GIT or QFT-GIT-alone depending on the attending physician's choice. We compared the screening strategies of QFT-GIT alone and in combination with TST. Overall, 338 (71.0%) patients received LTBI screening tests using the combination of TST and QFT-GIT, and 138 (29.0%) received QFT-GIT-alone. In addition, the LTBI tests were positive in 159 (47.0%) of 338 patients using the combination tests, and 43.8% (148/338) required LTBI treatment. Meanwhile, the LTBI tests were positive in 32.6% (45/138) of QFT-GIT-alone patients, and 30.4% (42/138) required LTBI treatment. Among 338 patients who received combination tests, 2 patients developed active tuberculosis within 1 year after the TNF inhibitor initiation. Of patients who received QFT-GIT-alone, no patient developed tuberculosis. In conclusion, among patients who received QFT-GIT-alone, the number of patients who required LTBI treatment declined compared to the TST and QFT-GIT combination, and none developed active tuberculosis within 1 year, suggesting that QFT-GIT-alone could be a potential screening strategy for diagnosing LTBI in patients with inflammatory arthritis in South Korea.

MeSH terms

Adult
Aged
Aged, 80 and over
Arthritis, Rheumatoid / complications
Arthritis, Rheumatoid / diagnosis*
Arthritis, Rheumatoid / drug therapy
Arthritis, Rheumatoid / pathology
Female
Humans
Inflammation / complications
Inflammation / drug therapy
Inflammation / pathology
Interferon-gamma Release Tests*
Latent Tuberculosis / diagnosis*
Latent Tuberculosis / drug therapy
Latent Tuberculosis / pathology
Male
Mass Screening
Middle Aged
Republic of Korea / epidemiology
Spondylitis, Ankylosing / diagnosis
Spondylitis, Ankylosing / drug therapy
Spondylitis, Ankylosing / pathology
Tertiary Care Centers
Tuberculin Test*
Tumor Necrosis Factor-alpha / antagonists & inhibitors

Substances

Tumor Necrosis Factor-alpha

Grants and funding

The authors received no specific funding for this work.