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Tuberculin skin test conversion in patients under treatment with anti-tumor necrotizing factor alpha agents.
BMC Infect Dis. 2020 Jul 02; 20(1):464.BI

Abstract

BACKGROUND

Despite successful clinical outcomes of biologic medications in patients with chronic rheumatic diseases, some considerable adverse effects such as infections remain a major concern. Possibility of tuberculosis (TB) reactivation over treatment with anti-tumor necrotizing factor (TNF) alpha agents has necessitated a screening test before initiation of treatment. However, screening over the course of treatment is not recommended in those patients with negative baseline screening tests. This study aimed to evaluate the efficacy of tuberculin skin test (TST) before treatment in patients with chronic rheumatologic diseases who were indicated to receive anti-TNF-alpha therapy and the necessity of repeating this test over the course of treatment.

METHODS

In this prospective study, patients with chronic rheumatologic diseases receiving anti-TNF-alpha agents were studied in a two-year period. TST was performed before treatment and those with positive results were excluded from the study. Thereafter, treatment with anti-TNF-alpha agents was initiated with the indicated dose. TST was repeated before administration of biologic treatment until TST became positive or 16 weeks after the initiation of treatment with anti-TNF-alpha.

RESULTS

A total of 51 cases were studied, of whom one patient (1.9%) was excluded due to positive TST before treatment. All participants received infliximab and the TST test became positive in one patient (2%) 2 weeks after receiving the first dose. Also, the results of further tests at weeks 6, 10, and 14 were all negative for the remaining patients.

CONCLUSION

Due to the possibility of TST conversion after administration of anti-TNF-alpha therapy, it is important to consider TB monitoring in patients under treatment with these agents using available methods such as TST.

Authors+Show Affiliations

Internal medicine department, Tabriz University of Medical Sciences, Tabriz, Iran.Internal medicine department, Tabriz University of Medical Sciences, Tabriz, Iran. dr.atefeahmadzade@gmail.com.Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.Internal medicine department, Tabriz University of Medical Sciences, Tabriz, Iran.Internal medicine department, Tabriz University of Medical Sciences, Tabriz, Iran.Internal medicine department, Tabriz University of Medical Sciences, Tabriz, Iran.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32615992

Citation

Hejazi, Mohammad-Esmaeil, et al. "Tuberculin Skin Test Conversion in Patients Under Treatment With Anti-tumor Necrotizing Factor Alpha Agents." BMC Infectious Diseases, vol. 20, no. 1, 2020, p. 464.
Hejazi ME, Ahmadzadeh A, Khabbazi A, et al. Tuberculin skin test conversion in patients under treatment with anti-tumor necrotizing factor alpha agents. BMC Infect Dis. 2020;20(1):464.
Hejazi, M. E., Ahmadzadeh, A., Khabbazi, A., Ebrahimi, A., Farmani, M., & Hejazi, Y. (2020). Tuberculin skin test conversion in patients under treatment with anti-tumor necrotizing factor alpha agents. BMC Infectious Diseases, 20(1), 464. https://doi.org/10.1186/s12879-020-05166-5
Hejazi ME, et al. Tuberculin Skin Test Conversion in Patients Under Treatment With Anti-tumor Necrotizing Factor Alpha Agents. BMC Infect Dis. 2020 Jul 2;20(1):464. PubMed PMID: 32615992.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tuberculin skin test conversion in patients under treatment with anti-tumor necrotizing factor alpha agents. AU - Hejazi,Mohammad-Esmaeil, AU - Ahmadzadeh,Atefeh, AU - Khabbazi,Alireza, AU - Ebrahimi,Aliasghar, AU - Farmani,Maryam, AU - Hejazi,Yasin, Y1 - 2020/07/02/ PY - 2020/01/09/received PY - 2020/06/17/accepted PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline KW - Anti-TNF-alpha agents KW - Tuberculin skin test KW - Tuberculosis SP - 464 EP - 464 JF - BMC infectious diseases JO - BMC Infect. Dis. VL - 20 IS - 1 N2 - BACKGROUND: Despite successful clinical outcomes of biologic medications in patients with chronic rheumatic diseases, some considerable adverse effects such as infections remain a major concern. Possibility of tuberculosis (TB) reactivation over treatment with anti-tumor necrotizing factor (TNF) alpha agents has necessitated a screening test before initiation of treatment. However, screening over the course of treatment is not recommended in those patients with negative baseline screening tests. This study aimed to evaluate the efficacy of tuberculin skin test (TST) before treatment in patients with chronic rheumatologic diseases who were indicated to receive anti-TNF-alpha therapy and the necessity of repeating this test over the course of treatment. METHODS: In this prospective study, patients with chronic rheumatologic diseases receiving anti-TNF-alpha agents were studied in a two-year period. TST was performed before treatment and those with positive results were excluded from the study. Thereafter, treatment with anti-TNF-alpha agents was initiated with the indicated dose. TST was repeated before administration of biologic treatment until TST became positive or 16 weeks after the initiation of treatment with anti-TNF-alpha. RESULTS: A total of 51 cases were studied, of whom one patient (1.9%) was excluded due to positive TST before treatment. All participants received infliximab and the TST test became positive in one patient (2%) 2 weeks after receiving the first dose. Also, the results of further tests at weeks 6, 10, and 14 were all negative for the remaining patients. CONCLUSION: Due to the possibility of TST conversion after administration of anti-TNF-alpha therapy, it is important to consider TB monitoring in patients under treatment with these agents using available methods such as TST. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/32615992/Tuberculin_skin_test_conversion_in_patients_under_treatment_with_anti-tumor_necrotizing_factor_alpha_agents L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-05166-5 DB - PRIME DP - Unbound Medicine ER -
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