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J Crohns Colitis. 2018 Jul 21. doi: 10.1093/ecco-jcc/jjy104. [Epub ahead of print]

Serial Tuberculin Skin Tests Improves the Detection of Latent Tuberculosis Infection in Patients with Inflammatory Bowel Disease.

Author information

1
Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
2
Department of Gastroenterology, Hospital Infanta Leonor, Madrid, Spain.
3
Department of Gastroenterology, Hospital Universitario Central de Asturias and Instituto de Investigación Biosanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
4
Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
5
Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain.
6
Department of Gastroenterology, Hospital La Paz, Madrid, Spain.
7
Department of Gastroenterology, Hospital de Galdakao, Galdakao, Spain.
8
Department of Gastroenterology, Hospital Clínico universitario de Santiago, Santiago de Compostela, Spain.
9
Department of Gastroenterology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain.
10
Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
11
Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain.
12
Department of Gastroenterology, Hospital Puerta de Hierro, Madrid, Spain.
13
Department of Gastroenterology, Hospital Reina Sofía, Córdoba, Spain.
14
Department of Gastroenterology, Hospitales Virgen Macarena-Rocío, Sevilla, Spain.
15
Department of Gastroenterology, Hospital de Manises, Manises, Spain.
16
Department of Gastroenterology, Hospital Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
17
Department of Gastroenterology, Hospital Universitario de Canarias, La Laguna, Spain.
18
Department of Gastroenterology, Hospital La Fe, Valencia, Spain.
19
Department of Gastroenterology, Hospital Universitario de Torrejón, Madrid, Spain.
20
Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain.
21
Department of Gastroenterology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
22
Department of Gastroenterology, Hospital Clínico de Valladolid, Valladolid, Spain.
23
Department of Gastroenterology, Complejo Hospitalario de Navarra and Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
24
Department of Gastroenterology, Hospital Universitario Cruces, Bilbao, Spain.
25
Department of Gastroenterology, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.

Abstract

Aim:

To assess the likelihood of detecting latent tuberculosis infection (LTBI) by the positive conversion of a serial tuberculin skin test (TST) at 1 year in inflammatory bowel disease (IBD) patients with negative baseline 2-step TST.

Methods:

In this multicentre prospective cohort study we evaluated rate and predictors of conversion of TST at 1 year in patients with negative baseline TST. We also evaluated management of patients who had a positive TST at baseline or a conversion at 1 year. In all patients we assessed TB cases occurring during follow-up.

Results:

Of the 192 IBD patients receiving anti-TNF and 220 IBD controls not receiving anti-TNF, 35 (8.5%, 95% CI 5.7-11.3) had positive conversion (median TST induration 13 mm, IQR 9-16). Ten anti-TNF cohort patients (5.2%, 95% CI 2.5-9.5) versus 25 controls (11.4%, 95% CI 7.5%-16.3%) had TST conversion (P=0.029). In multivariate analysis, conversion was associated with smoking habit (odds ratio [OR] 2.19, 95% CI 1.08-3.97; P=0.028). Anti-TNF-treated patients had a lower conversion rate (OR 0.41, 95% CI 0.20-0.83; P=0.013). The likelihood of conversion correlates with fewer immunosuppressive therapies between baseline TST and TST at 1 year (P=0.042). One case of active TB (isoniazid resistant strain) occurred in a patient with positive baseline TST receiving anti-TNF (0.05 events/100 patient-years).

Conclusions:

Serial TST at 1 year can detect LTBI in IBD patients receiving anti-TNF therapy with negative baseline TST. Serial TST seems to be advisable to reduce the risk of TB cases associated with inability to detect LTBI in pre-treatment screening.

PMID:
30052856
DOI:
10.1093/ecco-jcc/jjy104

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