RT Journal Article
T1 Dual latent tuberculosis screening with tuberculin skin tests and QuantiFERON-TB assays before TNF-α inhibitor initiation in children in Spain.
A1 Calzada-Hernandez, Joan
A1 Anton, Jordi
A1 Martin-de-Carpi, Javier
A1 Lopez-Montesinos, Berta
A1 Calvo, Inmaculada
A1 Donat, Ester
A1 Nuñez, Esmeralda
A1 Blasco-Alonso, Javier
A1 Mellado, Maria Jose
A1 Baquero-Artigao, Fernando
A1 Leis, Rosaura
A1 Vegas-Alvarez, Ana Maria
A1 Medrano-San-Ildefonso, Marta
A1 Pinedo-Gago, Maria Del Carmen
A1 Eizaguirre, Francisco Javier
A1 Tagarro, Alfredo
A1 Camacho-Lovillo, Marisol
A1 Perez-Gorricho, Beatriz
A1 Gavilan-Martin, Cesar
A1 Guillen, Sara
A1 Sevilla-Perez, Belen
A1 Peña-Quintana, Luis
A1 Mesa-Del-Castillo, Pablo
A1 Fortuny, Claudia
A1 Tebruegge, Marc
A1 Noguera-Julian, Antoni
K1 Inflammatory bowel disease
K1 Interferon-gamma release assay
K1 Juvenile idiopathic arthritis
K1 Pediatrics
K1 Tuberculosis
AB Tumor-necrosis-factor-α inhibitors (anti-TNF-α) are associated with an increased risk of tuberculosis (TB) disease, primarily due to reactivation of latent TB infection (LTBI). We assessed the performance of parallel LTBI screening with tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube assays (QFT-GIT) before anti-TNF-α treatment in children with immune-mediated inflammatory disorders in a low TB-burden setting. We conducted a multicenter cohort study involving 17 pediatric tertiary centers in Spain. LTBI was defined as the presence of a positive TST and/or QFT-GIT result without clinical or radiological signs of TB disease. A total of 270 patients (median age:11.0 years) were included, mainly with rheumatological (55.9%) or inflammatory bowel disease (34.8%). Twelve patients (4.4%) were diagnosed with TB infection at screening (LTBI, n = 11; TB disease, n = 1). Concordance between TST and QFT-GIT results was moderate (TST+/QFT-GIT+, n = 4; TST-/QFT-GIT+, n = 3; TST+/QFT-GIT-, n = 5; kappa coefficient: 0.48, 95% CI: 0.36-0.60). Indeterminate QFT-GIT results occurred in 10 patients (3.7%) and were associated with young age and elevated C-reactive protein concentrations. Eleven of 12 patients with TB infection uneventfully completed standard LTBI or TB treatment. During a median follow-up period of 6.4 years, only 2 patients developed TB disease (incidence density: 130 (95% CI: 20-440) per 100,000 person-years), both probable de novo infections. A substantial number of patients were diagnosed with LTBI during screening. The dual strategy identified more cases than either of the tests alone, and test agreement was only moderate. Our data show that in children in a low TB prevalence setting, a dual screening strategy with TST and IGRA before anti-TNF-α treatment is effective. • The optimal screening strategy for latent tuberculosis in children with immune-mediated inflammatory disorders remains uncertain. • Children receiving anti-TNF-α drugs are at increased risk of developing severe tuberculosis disease. • A dual screening strategy, using TST and an IGRA assay, identified more children with latent tuberculosis than either of the tests alone. • Identification and treatment of latent tuberculosis before initiation of anti-TNF-α therapy averted incident tuberculosis cases.
PB Springer
YR 2022
FD 2022-11-05
LK http://hdl.handle.net/10668/20186
UL http://hdl.handle.net/10668/20186
LA en
DS RISalud
RD Apr 7, 2025