PMID- 25313252
OWN - NLM
STAT- MEDLINE
DCOM- 20150911
LR  - 20150114
IS  - 1537-6591 (Electronic)
IS  - 1058-4838 (Linking)
VI  - 60
IP  - 3
DP  - 2015 Feb 1
TI  - Prevention of anti-tumor necrosis factor-associated tuberculosis: a 10-year 
      longitudinal cohort study.
PG  - 349-56
LID - 10.1093/cid/ciu796 [doi]
AB  - BACKGROUND: The extent to which anti-tumor necrosis factor (TNF)-associated 
      tuberculosis can be prevented is unclear, and there is no established guidance on 
      the optimal screening strategy for latent tuberculosis (LTBI) in patients about 
      to start anti-TNF therapy. We aimed to determine the effectiveness of a 
      comprehensive program for the prevention of anti-TNF-associated tuberculosis, and 
      to evaluate 3 LTBI screening strategies and the need for retesting patients with 
      negative results at baseline. METHODS: In total, 726 patients were screened prior 
      to anti-TNF therapy using 1 of 3 diagnostic strategies over 3 consecutive 
      periods: first, a 2-step tuberculin skin test (TST); second, a 2-step TST plus 
      QuantiFERON-TB Gold In-Tube test (QFT-GIT) (2-step TST/QFT); and third, a 
      single-step TST plus QFT-GIT (TST/QFT). Infected patients were offered preventive 
      therapy. We assessed differences in the incidence of tuberculosis between 
      anti-TNF exposed and nonexposed patients, and between the 3 study periods. 
      RESULTS: Tuberculosis developed during the first year in 2.85 per 1000 exposed 
      patient-years (3/1052 patient-years) and 1.77 per 1000 nonexposed patient-years 
      (1/566 patient-years). No cases occurred beyond the first year of treatment. LTBI 
      diagnoses decreased with the single-step TST/QFT (26.5%) compared with the 2-step 
      TST (42.5%; P < .001) and 2-step TST/QFT (38.5%; P = .02); the incidence of 
      tuberculosis among exposed patients did not change significantly across the 3 
      periods (2.63/1000, 3.91/1000, and 2.4/1000 patient-years, respectively). 
      CONCLUSIONS: Although anti-TNF-associated tuberculosis can be reduced, some risk 
      remains during the first year of therapy. Neither the 2-step TST nor systematic 
      retesting after negative baseline testing is justified.
CI  - (c) The Author 2014. Published by Oxford University Press on behalf of the 
      Infectious Diseases Society of America. All rights reserved. For Permissions, 
      please e-mail: journals.permissions@oup.com.
FAU - Munoz, Laura
AU  - Munoz L
AD  - Department of Infectious Diseases, Bellvitge University Hospital-Institut 
      d'investigacio biomedica de Bellvitge (IDIBELL).
FAU - Casas, Susana
AU  - Casas S
AD  - Department of Internal Medicine, Hospital Dos de Maig, Consorci Sanitari 
      Integral.
FAU - Juanola, Xavier
AU  - Juanola X
AD  - Department of Rheumatology, Bellvitge University Hospital-IDIBELL Clinical 
      Sciences Department, University of Barcelona.
FAU - Bordas, Xavier
AU  - Bordas X
AD  - Clinical Sciences Department, University of Barcelona Department of Dermatology, 
      Bellvitge University Hospital-IDIBELL, Barcelona, Spain.
FAU - Martinez, Concepcion
AU  - Martinez C
AD  - Department of Infectious Diseases, Bellvitge University Hospital-Institut 
      d'investigacio biomedica de Bellvitge (IDIBELL).
FAU - Santin, Miguel
AU  - Santin M
CN  - Prevention of Anti-TNF-Associated Tuberculosis Study Team of Bellvitge University 
      Hospital
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20141013
PL  - United States
TA  - Clin Infect Dis
JT  - Clinical infectious diseases : an official publication of the Infectious Diseases 
      Society of America
JID - 9203213
RN  - 0 (Tumor Necrosis Factor-alpha)
SB  - IM
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Latent Tuberculosis/etiology/*prevention & control
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Risk Assessment
MH  - Tuberculin Test
MH  - Tumor Necrosis Factor-alpha/*antagonists & inhibitors
OTO - NOTNLM
OT  - IGRAs
OT  - QuantiFERON-TB Gold In-Tube
OT  - anti-TNF
OT  - latent tuberculosis infection
OT  - tuberculosis
EDAT- 2014/10/15 06:00
MHDA- 2015/09/12 06:00
CRDT- 2014/10/15 06:00
PHST- 2014/10/15 06:00 [entrez]
PHST- 2014/10/15 06:00 [pubmed]
PHST- 2015/09/12 06:00 [medline]
AID - ciu796 [pii]
AID - 10.1093/cid/ciu796 [doi]
PST - ppublish
SO  - Clin Infect Dis. 2015 Feb 1;60(3):349-56. doi: 10.1093/cid/ciu796. Epub 2014 Oct 
      13.