Screening for latent tuberculosis before starting TNF-alpha inhibitors in a population with high BCG vaccination rates.
BCG vaccine
Isoniazid
Tuberculin test
Tuberculosis
Tumor necrosis factor-alpha
Journal
Rheumatology international
ISSN: 1437-160X
Titre abrégé: Rheumatol Int
Pays: Germany
ID NLM: 8206885
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
received:
12
05
2021
accepted:
14
06
2021
pubmed:
7
7
2021
medline:
20
7
2022
entrez:
6
7
2021
Statut:
ppublish
Résumé
It is assumed that in candidates for TNF-alpha inhibitor (TNFi) treatment, tuberculin skin test (TST) may be unreliable, since BCG vaccination causes false positive and drugs cause false negative results, favoring the use of Quantiferon or T-spot assays. However, these tests may not be readily available in all parts of the world. We aimed to determine the reliability of TST with respect to BCG vaccination and drugs in candidates for TNFi treatment, and how isoniazid is tolerated, assuming that the use of TST would result in increased isoniazid use. We included 1031 adult patients who were prescribed a TNFi for the first time. We analysed the association of BCG and drugs with TST and Quantiferon results, the determinants of a positive TST, and evaluated the tolerability of isoniazid. BCG vaccination and male sex were associated with positive TST (OR 3.56, 95% CI 1.98-6.41 and OR 2.54, 95% CI 1.75-3.68, respectively), while prednisolone and azathioprine were associated with negative TST (OR 0.63, 95% CI 0.43-0.91 and OR 0.40, 95% CI 0.11-0.76). Isoniazid was prescribed to 684 (66.3%) patients and had to be discontinued in 12.2% of these before 9 months, most commonly due to hepatotoxicity (44%). One patient developed tuberculosis despite isoniazid use. BCG vaccination may be associated with false positive TST, despite a long time since vaccination in candidates for TNFi treatment. Prednisolone and azathioprine use were associated with negative TST. Despite the high frequency of isoniazid use associated with using TST instead of QTF, isoniazid was generally well tolerated.
Identifiants
pubmed: 34228162
doi: 10.1007/s00296-021-04926-z
pii: 10.1007/s00296-021-04926-z
doi:
Substances chimiques
BCG Vaccine
0
Tumor Necrosis Factor Inhibitors
0
Prednisolone
9PHQ9Y1OLM
Azathioprine
MRK240IY2L
Isoniazid
V83O1VOZ8L
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1443-1451Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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