Assessing latent tuberculosis infection prior to biologic therapy in psoriasis: a new diagnostic approach with an online interpreter

Abstract

Purpose: The use of biological agents, particularly anti-TNF-alpha treatments, is associated with an elevated risk of tuberculosis (TB). Hence, a comprehensive assessment of latent tuberculosis infection (LTBI) before biologic therapies is imperative. The objective of this study was to evaluate the utility of an online tuberculin skin test (TST)/ interferon-γ release assay (IGRA) interpreter (OI-TST/IGRA) in assessing the risk of LTBI prior to initiating biological therapies in psoriasis patients. Materials and methods: 116 psoriasis patients who were previously evaluated for TB by a pulmonologist before being treated with a biologic agent were re-evaluated retrospectively with OI-TST/IGRA (tstin3d.com). Mean positive predictive value (PPV), mean annual risk of development of active tuberculosis (ARDATB), and mean cumulative risk of active tuberculosis (CRATB) values were calculated with OI-TST/IGRA and compared with previous results. Group comparisons were performed using Kruskal-Wallis and Mann-Whitney U tests. Results: The PPV of the LTBI-positive group was significantly higher than the LTBI-negative group. The PPV and ARDATB values of the TST size of >15 mm group were significantly higher than the TST size of 5-9 mm and TST size of 10-15 mm groups. The PPV, ARDATB, and CRATB values of the QuantiFERON-TB Gold Intube test (QFT-GIT)-positive group were significantly higher than the QFT-GIT-negative group. And the same values of the chest X-ray (CXR)-positive group were significantly higher than the CXR-negative group. The PPV, ARDATB, and CRATB values were positively correlated with TST, QFT-GIT and CXR results. In addition, the PPV was positively correlated with previous LTBI decisions. Conclusion: OI-TST/IGRA in which many factors are questioned and PPV, ARDATB, and CRATB values are evaluated together, may be a valuable tool for assessing the risk of active TB in psoriasis patients and preventing overdiagnosis and unnecessary prophylaxis.

Keywords

• Latent tuberculosis infection
• psoriasis
• biologic therapy

Psoriasis'te biyolojik tedavi öncesi latent tüberküloz enfeksiyonunun değerlendirilmesi: web tabanlı yorumlayıcı ile yeni bir tanı yaklaşımı

Abstract

Amaç: Biyolojik ajanların, özellikle de anti-TNF-alfa tedavilerinin kullanımı artmış tüberküloz (TB) riski ile ilişkilidir. Bu nedenle, biyolojik tedavilerden önce latent tüberküloz enfeksiyonunun (LTBI) kapsamlı bir şekilde değerlendirilmesi gereklidir. Bu çalışmanın amacı, psöriazis hastalarında biyolojik tedavilere başlamadan önce LTBI riskini değerlendirmek için web tabanlı bir uygulama olan tüberkülin deri testi (TST) /interferon-γ salınım testi (IGRA) (OI-TST/IGRA) yorumlayıcısının faydasını değerlendirmektir. Gereç ve yöntem: Biyolojik bir ajanla tedavi edilmeden önce göğüs hastalıkları uzmanı tarafından TB açısından değerlendirilen 116 psoriasis hastası retrospektif olarak OI-TST/IGRA (tstin3d.com) ile yeniden değerlendirildi. OI-TST/IGRA ile ortalama pozitif prediktif değer (PPV), ortalama yıllık aktif tüberküloz gelişme riski (ARDATB) ve ortalama kümülatif aktif tüberküloz riski (CRATB) değerleri hesaplandı ve önceki sonuçlarla karşılaştırıldı. Grup karşılaştırmaları Kruskal-Wallis ve Mann- Whitney U testleri kullanılarak yapılmıştır. Bulgular: LTBI-pozitif grubun PPV'si, LTBI-negatif gruptan anlamlı olarak daha yüksekti. TST boyutu >15 mm olan grubun PPV ve ARDATB değerleri, TST boyutu 5-9 mm ve TST boyutu 10-15 mm olan gruplardan anlamlı olarak daha yüksekti. QuantiFERON-TB Gold In-tube test (QFT-GIT) pozitif grubun PPV, ARDATB ve CRATB değerleri QFT-GIT negatif gruptan anlamlı derecede yüksekti. Akciğer grafisi (CXR) pozitif grubun aynı değerleri CXR negatif gruptan anlamlı derecede yüksekti. PPV, ARDATB ve CRATB değerleri TST, QFT-GIT ve CXR sonuçları ile pozitif korelasyon göstermiştir. Ayrıca, PPV önceki LTBI kararları ile pozitif korelasyon göstermiştir. Sonuç: Birçok faktörün sorgulandığı ve PPV, ARDATB ve CRATB değerlerinin birlikte değerlendirildiği OI-TST/ IGRA, psoriasis hastalarında TB riskinin değerlendirilmesinde, yanlış tanı ve gereksiz profilaksinin önlenmesinde değerli bir araç olabilir.

Keywords

• Latent tuberculosis infection
• psoriasis
• biologic therapy

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