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Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment.
Pathog Immun. 2020; 5(1):34-51.PI

Abstract

Background

To determine the conversion and reversion rates of tuberculosis (TB) screening tests (Tuberculin Skin Test-TST, Interferon Gamma Release Assay-IGRA: T-SPOT.TB) during biologic treatment in patients with rheumatic diseases and negative baseline screening.

Methods

This was a long-term, longitudinal cohort study of 50 patients with rheumatic diseases and negative baseline TB screening (TST: < 5 mm, negative T-SPOT.TB) treated with tumor necrosis factor inhibitors (TNFi) or other non-TNFi biologics. Patients were rescreened at a mean time of 1.4 (first rescreening) and 6.9 (second rescreening) years from baseline, with both assays. The conversion (negative to positive) and reversion (positive to negative) rate was calculated for each TB screening test.

Results

Fifty patients (mean age = 60 years) with various rheumatic diseases (rheumatoid arthritis: n = 24, spondyloarthropathies: n = 23, other: n = 3) were enrolled. During the first phase (baseline to first rescreening), all patients were treated with TNFi while during the second phase (first to second rescreening), TNFi (54%) and non-TNFi (46%) were used. Fifteen patients (30%) displayed conversion of at least 1 screening assay during follow-up (10 at the first and 5 at the second rescreening). This conversion rate was higher with TST (n = 11, 22% or 3.47/100 patient-years) compared to T-SPOT.TB (n = 4, 8% or 1.74/100 patient-years). Among the 10 converters at the first rescreening, 5 received isoniazid (INH) preventive therapy and 5 did not; an equal number of patients (3/5, 60%) reverted to negative with or without INH therapy. None of the patients developed active TB during follow-up (6.9 ± 1.0 years).

Conclusions

Approximately one-third of patients with rheumatic diseases and negative baseline TB screening developed conversion of at least 1 screening test during long-term biologic treatment. This occurred most often with TST and was usually a transient event. These findings do not support routine serial TB retesting in biologic-treated patients with rheumatic diseases in the absence of TB risk factors.

Authors+Show Affiliations

Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit; 2nd Department of Medicine and Laboratory; Hippokration General Hospital; National and Kapodistrian University of Athens School of Medicine; Athens, Greece.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32258853

Citation

Thomas, Konstantinos, et al. "Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment." Pathogens & Immunity, vol. 5, no. 1, 2020, pp. 34-51.
Thomas K, Hadziyannis E, Hatzara C, et al. Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment. Pathog Immun. 2020;5(1):34-51.
Thomas, K., Hadziyannis, E., Hatzara, C., Makris, A., Tsalapaki, C., Lazarini, A., Klavdianou, K., Antonatou, K., Koutsianas, C., & Vassilopoulos, D. (2020). Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment. Pathogens & Immunity, 5(1), 34-51. https://doi.org/10.20411/pai.v5i1.349
Thomas K, et al. Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment. Pathog Immun. 2020;5(1):34-51. PubMed PMID: 32258853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conversion and Reversion Rates of Tuberculosis Screening Assays in Patients With Rheumatic Diseases and Negative Baseline Screening Under Long-Term Biologic Treatment. AU - Thomas,Konstantinos, AU - Hadziyannis,Emilia, AU - Hatzara,Chrisoula, AU - Makris,Anastasia, AU - Tsalapaki,Christina, AU - Lazarini,Argyro, AU - Klavdianou,Kalliopi, AU - Antonatou,Katerina, AU - Koutsianas,Christos, AU - Vassilopoulos,Dimitrios, Y1 - 2020/02/26/ PY - 2020/01/13/received PY - 2020/01/27/accepted PY - 2020/4/8/entrez PY - 2020/4/8/pubmed PY - 2020/4/8/medline KW - Latent tuberculosis infection KW - biologic DMARDs KW - interferon-gamma releasing assays KW - rheumatic diseases KW - tuberculin skin test SP - 34 EP - 51 JF - Pathogens & immunity JO - Pathog Immun VL - 5 IS - 1 N2 - Background: To determine the conversion and reversion rates of tuberculosis (TB) screening tests (Tuberculin Skin Test-TST, Interferon Gamma Release Assay-IGRA: T-SPOT.TB) during biologic treatment in patients with rheumatic diseases and negative baseline screening. Methods: This was a long-term, longitudinal cohort study of 50 patients with rheumatic diseases and negative baseline TB screening (TST: < 5 mm, negative T-SPOT.TB) treated with tumor necrosis factor inhibitors (TNFi) or other non-TNFi biologics. Patients were rescreened at a mean time of 1.4 (first rescreening) and 6.9 (second rescreening) years from baseline, with both assays. The conversion (negative to positive) and reversion (positive to negative) rate was calculated for each TB screening test. Results: Fifty patients (mean age = 60 years) with various rheumatic diseases (rheumatoid arthritis: n = 24, spondyloarthropathies: n = 23, other: n = 3) were enrolled. During the first phase (baseline to first rescreening), all patients were treated with TNFi while during the second phase (first to second rescreening), TNFi (54%) and non-TNFi (46%) were used. Fifteen patients (30%) displayed conversion of at least 1 screening assay during follow-up (10 at the first and 5 at the second rescreening). This conversion rate was higher with TST (n = 11, 22% or 3.47/100 patient-years) compared to T-SPOT.TB (n = 4, 8% or 1.74/100 patient-years). Among the 10 converters at the first rescreening, 5 received isoniazid (INH) preventive therapy and 5 did not; an equal number of patients (3/5, 60%) reverted to negative with or without INH therapy. None of the patients developed active TB during follow-up (6.9 ± 1.0 years). Conclusions: Approximately one-third of patients with rheumatic diseases and negative baseline TB screening developed conversion of at least 1 screening test during long-term biologic treatment. This occurred most often with TST and was usually a transient event. These findings do not support routine serial TB retesting in biologic-treated patients with rheumatic diseases in the absence of TB risk factors. SN - 2469-2964 UR - https://www.unboundmedicine.com/medline/citation/32258853/Conversion_and_Reversion_Rates_of_Tuberculosis_Screening_Assays_in_Patients_With_Rheumatic_Diseases_and_Negative_Baseline_Screening_Under_Long_Term_Biologic_Treatment_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32258853/ DB - PRIME DP - Unbound Medicine ER -
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