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Screening for tuberculosis in patients candidates for anti -TNF therapy in inflammatory bowel disease (IBD)

A. Atanassova, I. Kotsev

Abstract

ECCO consensus guidelines recommend screening to rule out latent tuberculosis infection (LTI) in patients who are treated with anti-TNF. Quantiferon-TB-Gold in Tube® test (QFT-G-IT) in combination with the tuberculin skin test-TST may be useful in detecting LTI. We intend to evaluate the use of QFT-G-IT in combination with (TST, clinical data and chest x-ray) for LTI diagnosis in IBD patients. The aim was to evaluate the incidence of LTB and active TB (ATB) in IBD patients before and during aTNFT. Observational study of all patients with IBD candidates for biologic therapy in our hospital from April 2010 to December 2012 was carried out. The following data was collected: age, sex, immunosuppressive therapy, history of tuberculosis, history of vaccination, TST, QFT-G-IT and chest x-ray. A total of 34 IBD patients were recruited, all candidates for biologic therapy, at a mean age of 38,.52 years (range 21-58), 23 Crohn`s disease and 10 ulcerative colitis). All the patients were BCG vaccinated. The TST was negative in all patients. Two Crohn`s disease patients were positive for QFT-G-IT before treatment with adalimumab (HumiraⓇ). Two patients with Crohn`s disease after four and eight months of biological therapy, respectively, also became positive for QFT-G-IT. LTI rate in our patients was 5,8% before treatment and 6,25% during the treatment. Chest x-ray was normal in all cases of LTB. Despite screening for LTB, one female ulcerative colitis patient on AZA therapy developed active tuberculosis (ATB). In conclusions, the incidence of LTB in our group before aTNFT was 5,8%, similar to data of other investigator groups. The concordance between the two tests QFTG- IT and TST in IBD patients in our series is poor. QFT-G-IT can be a useful tool that can optimize the diagnosis of LTI.




DOI: http://dx.doi.org/10.14748/ssm.v45i0.910

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About The Authors

A. Atanassova
St. Marina University Hospital of Varna
Bulgaria

Clinic of Gastroenterology

I. Kotsev
St. Marina University Hospital of Varna
Bulgaria

Clinic of Gastroenterology

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