The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation

Shahrad Hakimian,1 Yevgeniy Popov,1 Abbas H Rupawala,2 Karen Salomon-Escoto,3 Steven Hatch,4 Randall Pellish1,2 1Department of Medicine, 2Division of Gastroenterology, 3Division of Rheumatology, 4Division of Infectious Disease, UMass Memorial Medical Center, Worcester, MA, USA Background: Tumor necr...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Hakimian S, Popov Y, Rupawala AH, Salomon-Escoto K, Hatch S, Pellish R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Indeterminate Quantiferon Gold Latent TB infection Inflammatory Bowel Disease Rheumatoid Arthritis Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/d9826e472f5747949dfcb09d3002e73c
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:d9826e472f5747949dfcb09d3002e73c
record_format	dspace
spelling	oai:doaj.org-article:d9826e472f5747949dfcb09d3002e73c2021-12-02T07:15:07ZThe conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation1177-5491https://doaj.org/article/d9826e472f5747949dfcb09d3002e73c2018-02-01T00:00:00Zhttps://www.dovepress.com/the-conundrum-of-indeterminate-quantiferon-tb-gold-results-before--ant-peer-reviewed-article-BTThttps://doaj.org/toc/1177-5491Shahrad Hakimian,1 Yevgeniy Popov,1 Abbas H Rupawala,2 Karen Salomon-Escoto,3 Steven Hatch,4 Randall Pellish1,2 1Department of Medicine, 2Division of Gastroenterology, 3Division of Rheumatology, 4Division of Infectious Disease, UMass Memorial Medical Center, Worcester, MA, USA Background: Tumor necrosis factor alpha (TNFα) is a key cytokine in both the pathogenesis of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) and the host defense against tuberculosis (TB). Consequently, anti-TNFα medications result in an increased risk of latent TB infection (LTBI) reactivation. Here, we sought to evaluate the factors affecting the results of QuantiFERON-TB Gold In-Tube (QFT-GIT) assay as a screening tool for LTBI. Methods: We conducted an observational, retrospective study in patients with IBD and RA who underwent LTBI screening using QFT-GIT at UMass Memorial Medical Center between 2008 and 2016 prior to initiation of anti-TNF medications. Results: We included 107 and 89 patients with IBD and RA, respectively. We found that a higher proportion of IBD patients had indeterminate QFT-GIT result compared to RA patients. Furthermore, we found that the majority of patients with indeterminate results were tested during an acute flare of IBD (88%) and while taking corticosteroids. Of all patients receiving ≥20 mg equivalent prednisone dose (n=32), 63% resulted in indeterminate QFT-GIT, compared to only 6% indeterminate testing in patients receiving <20 mg of equivalent prednisone dose (n=164, P<0.001). There was no correlation between indeterminate results and age, gender, disease duration, or distribution, or smoking status within each population. Conclusion: We observed that high-dose corticosteroids may affect QFT-GIT outcomes leading to a high proportion of indeterminate results. We propose that IBD patients should be tested prior to initiation of corticosteroids to avoid equivocal results and prevent potential delays in initiation of anti-TNF medications. Keywords: indeterminate QuantiFERON-TB Gold, latent TB infection, inflammatory bowel disease, rheumatoid arthritis, corticosteroids, IBD flareHakimian SPopov YRupawala AHSalomon-Escoto KHatch SPellish RDove Medical PressarticleIndeterminate Quantiferon GoldLatent TB infectionInflammatory Bowel DiseaseRheumatoid ArthritisMedicine (General)R5-920ENBiologics: Targets & Therapy, Vol Volume 12, Pp 61-67 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Indeterminate Quantiferon Gold Latent TB infection Inflammatory Bowel Disease Rheumatoid Arthritis Medicine (General) R5-920
spellingShingle	Indeterminate Quantiferon Gold Latent TB infection Inflammatory Bowel Disease Rheumatoid Arthritis Medicine (General) R5-920 Hakimian S Popov Y Rupawala AH Salomon-Escoto K Hatch S Pellish R The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation
description	Shahrad Hakimian,1 Yevgeniy Popov,1 Abbas H Rupawala,2 Karen Salomon-Escoto,3 Steven Hatch,4 Randall Pellish1,2 1Department of Medicine, 2Division of Gastroenterology, 3Division of Rheumatology, 4Division of Infectious Disease, UMass Memorial Medical Center, Worcester, MA, USA Background: Tumor necrosis factor alpha (TNFα) is a key cytokine in both the pathogenesis of inflammatory bowel disease (IBD) and rheumatoid arthritis (RA) and the host defense against tuberculosis (TB). Consequently, anti-TNFα medications result in an increased risk of latent TB infection (LTBI) reactivation. Here, we sought to evaluate the factors affecting the results of QuantiFERON-TB Gold In-Tube (QFT-GIT) assay as a screening tool for LTBI. Methods: We conducted an observational, retrospective study in patients with IBD and RA who underwent LTBI screening using QFT-GIT at UMass Memorial Medical Center between 2008 and 2016 prior to initiation of anti-TNF medications. Results: We included 107 and 89 patients with IBD and RA, respectively. We found that a higher proportion of IBD patients had indeterminate QFT-GIT result compared to RA patients. Furthermore, we found that the majority of patients with indeterminate results were tested during an acute flare of IBD (88%) and while taking corticosteroids. Of all patients receiving ≥20 mg equivalent prednisone dose (n=32), 63% resulted in indeterminate QFT-GIT, compared to only 6% indeterminate testing in patients receiving <20 mg of equivalent prednisone dose (n=164, P<0.001). There was no correlation between indeterminate results and age, gender, disease duration, or distribution, or smoking status within each population. Conclusion: We observed that high-dose corticosteroids may affect QFT-GIT outcomes leading to a high proportion of indeterminate results. We propose that IBD patients should be tested prior to initiation of corticosteroids to avoid equivocal results and prevent potential delays in initiation of anti-TNF medications. Keywords: indeterminate QuantiFERON-TB Gold, latent TB infection, inflammatory bowel disease, rheumatoid arthritis, corticosteroids, IBD flare
format	article
author	Hakimian S Popov Y Rupawala AH Salomon-Escoto K Hatch S Pellish R
author_facet	Hakimian S Popov Y Rupawala AH Salomon-Escoto K Hatch S Pellish R
author_sort	Hakimian S
title	The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation
title_short	The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation
title_full	The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation
title_fullStr	The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation
title_full_unstemmed	The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation
title_sort	conundrum of indeterminate quantiferon-tb gold results before anti-tumor necrosis factor initiation
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/d9826e472f5747949dfcb09d3002e73c
work_keys_str_mv	AT hakimians theconundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT popovy theconundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT rupawalaah theconundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT salomonescotok theconundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT hatchs theconundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT pellishr theconundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT hakimians conundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT popovy conundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT rupawalaah conundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT salomonescotok conundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT hatchs conundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation AT pellishr conundrumofindeterminatequantiferontbgoldresultsbeforeantitumornecrosisfactorinitiation
_version_	1718399547412054016

The conundrum of indeterminate QuantiFERON-TB Gold results before anti-tumor necrosis factor initiation

Ejemplares similares