- Inflammatory bowel diseases
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Concordance between tuberculin skin test and interferon-gamma release assay for latent tuberculosis screening in inflammatory bowel disease
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Saad Alrajhi, Pascale Germain, Myriam Martel, Peter Lakatos, Talat Bessissow, Talal Al-Taweel, Waqqas Afif
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Intest Res 2020;18(3):306-314. Published online March 20, 2020
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DOI: https://doi.org/10.5217/ir.2019.00116
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 Abstract
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- Background/Aims
Latent tuberculosis screening is mandatory prior to initiating anti-tumor necrosis factor (anti-TNF) medications. Guidelines recommend interferon-gamma release assays (IGRA) as first line screening method for the general population. Studies provided conflicting evidence on IGRA and tuberculin skin test (TST) performance in inflammatory bowel disease (IBD) patients. We assessed test concordance and the effects of immunosuppression on their performance in IBD patients.
Methods
We searched MEDLINE, Embase and Cochrane databases (2011–2018) for studies testing TST and IGRA in IBD. Primary outcome was TST and IGRA concordance. Secondary outcomes were effects of immunosuppressive therapy on performance. Immunosuppression defined as either steroids, thiopurine, methotrexate or cyclosporine use. We used the pooled random effects model to adjust for heterogeneity analyzed using (I2–Q statistics). We compared the fixed model to exclude smaller study effects.
Results
Sixteen studies (2,488 patients) were included. Pooled TST and IGRA concordance was 85% (95% confidence interval [CI], 81%–88%; P=0.01). Effects of immunosuppression were reported in 8 studies (814 patients). The odds ratio of testing positive by IGRA decreased to 0.57 if immunosuppressed (95% CI, 0.31–1.03; P=0.06). The odds ratio of testing positive by TST if immunosuppressed was 1.14 (95% CI, 0.61–2.12; P=0.69). The fixed model yielded similar results, however the negative effect of immunosuppression on IGRA reached statistical significance (P=0.01).
Conclusions
While concordance was 85% between TST and IGRA, the performance of IGRA seems to be negatively affected by immunosuppression. Given the importance of detecting latent tuberculosis prior to anti-TNF initiation, further randomized controlled trials comparing the performance of TST and IGRA in IBD patients are needed.
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Citations
Citations to this article as recorded by  - Bronchoesophageal fistula in a patient with Crohn’s disease receiving anti-tumor necrosis factor therapy
Kyunghwan Oh, Kee Don Choi, Hyeong Ryul Kim, Tae Sun Shim, Byong Duk Ye, Suk-Kyun Yang, Sang Hyoung Park
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The Ewha Medical Journal.2021; 44(3): 93. CrossRef - Risk and characteristics of tuberculosis after anti-tumor necrosis factor therapy for inflammatory bowel disease: a hospital-based cohort study from Korea
Jae Yong Lee, Kyunghwan Oh, Hee Seung Hong, Kyuwon Kim, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Ho-Su Lee, Kyung-Wook Jo, Sang Hyoung Park
BMC Gastroenterology.2021;[Epub] CrossRef - Is Multidrug-resistant Extrapulmonary Tuberculosis Important? If So, What Is Our Strategy?
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The Ewha Medical Journal.2021; 44(4): 148. CrossRef
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