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Tuberculin skin test conversion in patients under treatment with anti-tumor necrotizing factor alpha agents

Mohammad-Esmaeil Hejazi1, Atefeh Ahmadzadeh2, Alireza Khabbazi3

  • 1Internal medicine department, Tabriz University of Medical Sciences, Tabriz, Iran.

BMC Infectious Diseases
|July 4, 2020
PubMed
Abstract

Insights

Tuberculosis (TB) screening with the tuberculin skin test (TST) before anti-tumor necrosis factor (TNF) therapy is crucial. Repeating TST during treatment can detect TB reactivation, essential for patient safety in chronic rheumatic diseases.

Area of Science:

  • Rheumatology
  • Infectious Diseases
  • Pharmacology

Background:

  • Biologic medications, including anti-tumor necrosis factor (TNF) alpha agents, are effective for chronic rheumatic diseases but carry risks like infections.
  • Tuberculosis (TB) reactivation is a significant concern with anti-TNF therapy, necessitating pre-treatment screening.
  • Current guidelines do not recommend repeat TB screening during anti-TNF therapy for patients with negative baseline tests.

Purpose of the Study:

  • To evaluate the efficacy of the tuberculin skin test (TST) for pre-treatment screening of TB in patients with chronic rheumatologic diseases starting anti-TNF-alpha therapy.
  • To determine the necessity of repeating TST during the course of anti-TNF-alpha treatment.

Main Methods:

  • A prospective study involving 51 patients with chronic rheumatologic diseases undergoing anti-TNF-alpha therapy over two years.
  • Tuberculin skin test (TST) performed before treatment; positive results led to exclusion.
  • TST was repeated during anti-TNF-alpha treatment up to 16 weeks or until conversion to positive.

Main Results:

  • One patient (1.9%) was excluded due to a positive pre-treatment TST.
  • One patient (2%) developed a positive TST two weeks after the first infliximab dose.
  • Subsequent TSTs at weeks 6, 10, and 14 remained negative for other participants.

Conclusions:

  • Tuberculin skin test (TST) conversion can occur after initiating anti-tumor necrosis factor (TNF) therapy.
  • Ongoing TB monitoring using methods like TST is important for patients receiving anti-TNF agents.
  • This highlights the need to reconsider repeat TB screening protocols during anti-TNF therapy.
Keywords:
Anti-TNF-alpha agentsTuberculin skin testTuberculosis

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