Evaluation of screening methods for identification of patients with chronic rheumatological disease requiring tuberculosis chemoprophylaxis prior to commencement of TNF-α antagonist therapy

Aran Singanayagam, Kavina Manalan, Saranya Sridhar, Philip L Molyneaux, David W Connell, Peter M George, Anne Kindelerer, Suranjith Seneviratne, Ajit Lalvani, Melissa Wickremasinghe (Lead / Corresponding author), Onn Min Kon

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    Abstract

    BACKGROUND: Patients undergoing tumour necrosis factor (TNF)-α antagonist therapy are at increased risk of latent tuberculosis infection (LTBI) reactivation. The aim of this study was to determine the optimum available screening strategy for identifying patients for tuberculosis (TB) chemoprophylaxis.

    METHODS: We conducted a prospective observational study of consecutive adults with chronic rheumatological disease referred for LTBI screening prior to commencement of TNF-α antagonist therapy. All patients included had calculation of TB risk according to age, ethnicity and year of UK entry, as described in the 2005 British Thoracic Society (BTS) guidelines and measurement of tuberculin skin test (TST) and T.Spot.TB.

    RESULTS: There were 187 patients included in the study, with 157 patients (84%) taking immunosuppressants. 137 patients would require further risk stratification according to the BTS algorithm, with 110 (80.3%) classified as being at low risk of having LTBI. There were 39 patients (35.5%) who were categorised as low risk but were either TST and/or T.Spot positive and would not have received chemoprophylaxis according to the BTS algorithm. Combination of all three methods (risk stratification and/or positive T.Spot and/or positive TST) identified 66 patients out of 137 who would potentially be offered chemoprophylaxis, which was greater than any single test or two-test combination.

    CONCLUSION: Performing both a TST and T.Spot in patients on immunosuppressants prior to commencement of TNF-α antagonist therapy gives an additional yield of potential LTBI compared with use of risk stratification tables alone. Our results suggest that use of all three screening modalities gives the highest yield of patients potentially requiring chemoprophylaxis.

    Original languageEnglish
    Pages (from-to)955-961
    Number of pages7
    JournalThorax
    Volume68
    Issue number10
    Early online date23 Aug 2013
    DOIs
    Publication statusPublished - Oct 2013

    Keywords

    • Adult
    • Aged
    • Antitubercular Agents/therapeutic use
    • Chemoprevention
    • Chronic Disease
    • Female
    • Humans
    • Immunosuppressive Agents/adverse effects
    • Latent Tuberculosis/complications
    • Male
    • Mass Screening/methods
    • Middle Aged
    • Prospective Studies
    • Rheumatic Diseases/complications
    • Risk Assessment
    • Tuberculin Test/methods
    • Tumor Necrosis Factor-alpha/antagonists & inhibitors
    • United Kingdom

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  • Cite this

    Singanayagam, A., Manalan, K., Sridhar, S., Molyneaux, P. L., Connell, D. W., George, P. M., Kindelerer, A., Seneviratne, S., Lalvani, A., Wickremasinghe, M., & Kon, O. M. (2013). Evaluation of screening methods for identification of patients with chronic rheumatological disease requiring tuberculosis chemoprophylaxis prior to commencement of TNF-α antagonist therapy. Thorax, 68(10), 955-961. https://doi.org/10.1136/thoraxjnl-2013-203436