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System for Efficacy and Cytotoxicity Screening of Inhibitors Targeting Intracellular Mycobacterium tuberculosis
Published on: April 5, 2017
Screening of tuberculosis before biologics
N Mrozek1, B Pereira, M Soubrier
1Service maladies infectieuses, hôpital G Montpied, Clermont-Ferrand, France.
Medecine Et Maladies Infectieuses
|September 13, 2011
Summary
Anti-TNF therapy for inflammatory rheumatism increases tuberculosis risk. Interferon-gamma release assays (IGRAs) show higher sensitivity than the tuberculin skin test (TST) for detecting latent tuberculosis infection, making TST screening unnecessary.
Area of Science:
- Rheumatology
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Anti-tumor necrosis factor (TNF) therapies have revolutionized chronic inflammatory rheumatism management.
- A significant concern with anti-TNF treatment is the increased risk of tuberculosis reactivation.
- Current screening for latent tuberculosis infection (LTBI) involves the intradermal tuberculin skin test (ITT) and interferon-gamma release assays (IGRAs).
Purpose of the Study:
- To compare the sensitivity and specificity of IGRAs (QuantiFERON and T-spot) against the ITT for detecting LTBI in patients initiating anti-TNF therapy.
- To evaluate screening methods using a standardized ITT threshold of 15mm, as recommended in France.
Main Methods:
- A meta-analysis was conducted on studies utilizing a 15mm threshold for ITT positivity.
- Sensitivity and specificity data for QuantiFERON, T-spot, and ITT were analyzed.
Main Results:
- The sensitivity of QuantiFERON was 79% (95% CI 76%-83%), T-spot was 84% (95% CI 75%-95%), and ITT was 69% (95% CI 65%-73%).
- Current French screening guidelines (history, physical exam, 5-unit ITT, chest X-ray) lead to treating 20%-30% of patients, with potential adverse effects.
Conclusions:
- Interferon-gamma release assays demonstrate superior sensitivity compared to the ITT for LTBI detection in this context.
- Given the high sensitivity and specificity of IGRAs, systematic TST screening before anti-TNF treatment is no longer justified.
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