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Performance of interferon-gamma release assay for tuberculosis screening in inflammatory bowel disease patients
Sunny H Wong1, Margaret Ip, Whitney Tang
1*Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, Department of Medicine and Therapeutics, and LKS Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China; †Department of Microbiology, The Chinese University of Hong Kong, Hong Kong, China; ‡Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong, China; and §Division of Infectious Disease, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Background:
Screening for latent tuberculosis (TB) is mandatory in inflammatory bowel disease (IBD) before starting anti-tumor necrosis factor therapy. Data on the utility of screening tests in populations with moderate background risk of TB are limited. This study aims to evaluate the performance of interferon-gamma release assay (IGRA) with QuantiFERON-TB Gold in IBD patients in a TB endemic region.
Methods:
Two hundred sixty-eight consecutive adult IBD patients and 234 healthy controls were prospectively recruited. Detailed clinical history, chest x-ray findings, and IGRA results were documented for all individuals. The IGRA positive rates between IBD patients, with or without immunosuppressant, and healthy controls were compared.
Results:
The IGRA result was positive in 21.9% of IBD patients and 19.2% of healthy controls (P = 0.535). IBD patients on immunosuppressive therapy had a significantly lower IGRA positive rate (13.0% versus 29.6%; P = 0.002) compared with immunosuppressant-naive IBD patients. This difference seemed to be most prominent for patients taking azathioprine (11.8% versus 27.3%, P = 0.006).
Conclusions:
IGRA results are negatively impacted by immunosuppressive therapy. Current guidelines suggesting TB screening before anti-tumor necrosis factor therapy may be inadequate in patients already on immunosuppressive drugs. Latent TB testing seems best performed before the initiation of immunosuppressive therapies in IBD patients.
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