Dynamic QuantiFERON Response in Psoriasis Patients Taking Long-Term Biologic Therapy

Overview

Journal Dermatol Ther (Heidelb)

Date 2013 Jul 27

PMID 23888257

Citations 4

Authors

Lorenzo Drago

Lucia Nicola

Valentina Signori

Elisa Palazzi

Cecilia Garutti

Samantha Spadino

Gianfranco Altomare

Affiliations

Soon will be listed here.

Abstract

Introduction: The risk of active tuberculosis is increased in psoriasis patients receiving biologic drug therapy. The QuantiFERON-TB Gold In-Tube assay (QFT) is used for latent tuberculosis screening in these patients. This study presents a retrospective analysis on repeated QFT assays, investigating the influence of biologic drugs and isoniazid therapy on the outcome of the assay.

Methods: Serial QFTs of 58 psoriasis patients, who received biologic drug therapy, were evaluated at baseline and after 12 months of treatment. Patients were retrospectively divided in four groups according to QFT results at baseline and at follow-up: patients having a QFT reversion (from positive to negative results); patients with a conversion (from negative to positive); patients confirming the baseline results, either positive or negative.

Results: At the end of the 12-months period, 11.1% of patients with a negative QFT result at baseline presented a conversion, showing low interferon (IFN)-gamma values, whereas 6.9% of positive patients presented a QFT reversion. When the test was repeated after 2-3 months without isoniazid chemoprophylaxis, patients with QFT conversion showed negative results. No patient developed active tuberculosis.

Conclusions: In patients undergoing biologic therapy, a positive QFT assay needs to be further confirmed, as false-positive results may occur after long-term therapy. Repeating QFT tests in patients with low IFN-gamma values could reduce the incidence of false-positive latent tuberculosis infection diagnosis, thus preventing unnecessary tuberculosis chemoprophylaxis. In conclusion, a dynamic QFT response is possible in psoriasis patients undergoing biologic therapy.

Citing Articles

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Management of psoriatic patients in biologic treatment associated with infectious comorbidities.

Nicoletta B, Alessandra N, Nevena S, Tolino E, Colapietra D, Claudio M Postepy Dermatol Alergol. 2020; 37(3):417-421.

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Challenges in screening for latent tuberculosis in inflammatory bowel disease prior to biologic treatment: a UK cohort study.

Thi A, Abbara A, Bouri S, Collin S, Wolfson P, Owen L Frontline Gastroenterol. 2018; 9(3):234-240.

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The role of interferon-gamma release assays in predicting the emergence of active tuberculosis in the setting of biological treatment: a case report and review of the literature.

Scrivo R, Sauzullo I, Mengoni F, Riccieri V, Altieri A, Cantoro L Clin Rheumatol. 2014; 35(5):1383-8.

PMID: 24827875 DOI: 10.1007/s10067-014-2669-0.

References

Dominguez J, Latorre I, Altet N, Mateo L, de Souza-Galvao M, Ruiz-Manzano J . IFN-gamma-release assays to diagnose TB infection in the immunocompromised individual. Expert Rev Respir Med. 2010; 3(3):309-27. DOI: 10.1586/ers.09.20. View

Helwig U, Muller M, Hedderich J, Schreiber S . Corticosteroids and immunosuppressive therapy influence the result of QuantiFERON TB Gold testing in inflammatory bowel disease patients. J Crohns Colitis. 2012; 6(4):419-24. DOI: 10.1016/j.crohns.2011.09.011. View

Chinen J, Shearer W . Secondary immunodeficiencies, including HIV infection. J Allergy Clin Immunol. 2010; 125(2 Suppl 2):S195-203. PMC: 6151868. DOI: 10.1016/j.jaci.2009.08.040. View

Panes J, Gomollon F, Taxonera C, Hinojosa J, Clofent J, Nos P . Crohn's disease: a review of current treatment with a focus on biologics. Drugs. 2007; 67(17):2511-37. DOI: 10.2165/00003495-200767170-00005. View

Ravn P, Munk M, Andersen A, Lundgren B, Lundgren J, Nielsen L . Prospective evaluation of a whole-blood test using Mycobacterium tuberculosis-specific antigens ESAT-6 and CFP-10 for diagnosis of active tuberculosis. Clin Diagn Lab Immunol. 2005; 12(4):491-6. PMC: 1074386. DOI: 10.1128/CDLI.12.4.491-496.2005. View

Chiu H, Hsueh P, Tsai T . Clinical experience of QuantiFERON(®) -TB Gold testing in patients with psoriasis treated with tumour necrosis factor blockers in Taiwan. Br J Dermatol. 2010; 164(3):553-9. DOI: 10.1111/j.1365-2133.2010.10137.x. View

Ashwell J, Lu F, Vacchio M . Glucocorticoids in T cell development and function*. Annu Rev Immunol. 2000; 18:309-45. DOI: 10.1146/annurev.immunol.18.1.309. View

Sivamani R, Goodarzi H, Garcia M, Raychaudhuri S, Wehrli L, Ono Y . Biologic therapies in the treatment of psoriasis: a comprehensive evidence-based basic science and clinical review and a practical guide to tuberculosis monitoring. Clin Rev Allergy Immunol. 2012; 44(2):121-40. DOI: 10.1007/s12016-012-8301-7. View

Connell T, Curtis N, Ranganathan S, Buttery J . Performance of a whole blood interferon gamma assay for detecting latent infection with Mycobacterium tuberculosis in children. Thorax. 2006; 61(7):616-20. PMC: 2104654. DOI: 10.1136/thx.2005.048033. View

10.

Minguez S, Latorre I, Mateo L, Lacoma A, Diaz J, Olive A . Interferon-gamma release assays in the detection of latent tuberculosis infection in patients with inflammatory arthritis scheduled for anti-tumour necrosis factor treatment. Clin Rheumatol. 2012; 31(5):785-94. DOI: 10.1007/s10067-012-1938-z. View

11.

Mazurek G, LoBue P, Daley C, Bernardo J, Lardizabal A, Bishai W . Comparison of a whole-blood interferon gamma assay with tuberculin skin testing for detecting latent Mycobacterium tuberculosis infection. JAMA. 2001; 286(14):1740-7. DOI: 10.1001/jama.286.14.1740. View

12.

Chiappini E, Fossi F, Bonsignori F, Sollai S, Galli L, de Martino M . Utility of interferon-γ release assay results to monitor anti-tubercular treatment in adults and children. Clin Ther. 2012; 34(5):1041-8. DOI: 10.1016/j.clinthera.2012.03.006. View

13.

Pathirana D, Nast A, Ormerod A, Reytan N, Saiag P, Smith C . On the development of the European S3 guidelines on the systemic treatment of psoriasis vulgaris: structure and challenges. J Eur Acad Dermatol Venereol. 2010; 24(12):1458-67. DOI: 10.1111/j.1468-3083.2010.03671.x. View

14.

Pai M, Zwerling A, Menzies D . Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med. 2008; 149(3):177-84. PMC: 2951987. DOI: 10.7326/0003-4819-149-3-200808050-00241. View

15.

Lalvani A, Nagvenkar P, Udwadia Z, Pathan A, Wilkinson K, Shastri J . Enumeration of T cells specific for RD1-encoded antigens suggests a high prevalence of latent Mycobacterium tuberculosis infection in healthy urban Indians. J Infect Dis. 2001; 183(3):469-77. DOI: 10.1086/318081. View

16.

Mancuso J, Mazurek G, Tribble D, Olsen C, Aronson N, Geiter L . Discordance among commercially available diagnostics for latent tuberculosis infection. Am J Respir Crit Care Med. 2011; 185(4):427-34. PMC: 3297098. DOI: 10.1164/rccm.201107-1244OC. View

17.

Lalvani A, Millington K . Screening for tuberculosis infection prior to initiation of anti-TNF therapy. Autoimmun Rev. 2008; 8(2):147-52. PMC: 2593775. DOI: 10.1016/j.autrev.2008.07.011. View

18.

Dominguez J, Latorre I . Role of the T-cell interferon-gamma release assays in preventing reactivation of latent tuberculosis infection in immunosuppressed patients in treatment with anti-TNF agents. J Crohns Colitis. 2010; 2(3):250-4. DOI: 10.1016/j.crohns.2008.05.007. View

19.

Sterry W, Barker J, Boehncke W, Bos J, Chimenti S, Christophers E . Biological therapies in the systemic management of psoriasis: International Consensus Conference. Br J Dermatol. 2004; 151 Suppl 69:3-17. DOI: 10.1111/j.1365-2133.2004.06070.x. View

20.

Carmona L, Gomez-Reino J, Rodriguez-Valverde V, Montero D, Pascual-Gomez E, Martin Mola E . Effectiveness of recommendations to prevent reactivation of latent tuberculosis infection in patients treated with tumor necrosis factor antagonists. Arthritis Rheum. 2005; 52(6):1766-72. DOI: 10.1002/art.21043. View