RT Journal Article
SR Electronic
T1 Preventing Tuberculosis Flare in Patients with Inflammatory Rheumatic Diseases Receiving Tumor Necrosis Factor-α Inhibitors in India — An Audit Report
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.081042
DO 10.3899/jrheum.081042
A1 Anand N. Malaviya
A1 Sanjiv Kapoor
A1 Shriram Garg
A1 Roopa Rawat
A1 Subramanian Shankar
A1 Savita Nagpal
A1 Dinesh Khanna
A1 Daniel E. Furst
YR 2009
UL http://www.jrheum.org/content/early/2009/05/27/jrheum.081042.abstract
AB Objective To test the efficacies of a strategy for preventing tuberculosis (TB) in Indian patients with inflammatory rheumatic diseases (IRD) treated with tumor necrosis factor-α (TNF-α) inhibitor. Methods The screening strategy included tuberculosis skin test (TST), QuantiFERON-TB Gold (QTG) test, standard chest radiograph, and contrast enhanced-computerized tomography of the chest (CT). Results Among 53 patients screened, 17 (32%) had ≥ 1 test positive, with 5 (9.4%) patients having TB infection (clinical, CT, biopsy). The remaining 12 patients showed latent TB; 1 additional patient with negative screening tests was diagnosed with latent TB retrospectively for he developed TB disease within a few weeks of receiving infliximab. The remaining 35 patients tested negative with all tests. The combination of 4 screening tests gave a sensitivity of 0.83, specificity of 0.74, positive predictive value (PPV) 0.29, and negative predictive value (NPV) 0.97. Only 22 patients could afford treatment with TNF-α inhibitors; 19 of them were negative in the screening tests. Three patients who were positive on TST and/or QTG received prophylactic treatment with TNF-α inhibitor. Since implementation of the screening strategy, only 1 of 22 (4.5%) patients given TNF-α inhibitor developed probable TB disease. Conclusion With the use of these 4 TB screening tests in India, where TB is highly prevalent, TB could be excluded with a high degree of certainty (NPV 0.97). However, as even this combination of tests has only moderate sensitivity and specificity and poor PPV for detecting TB, vigilance may be advisable even if only one of the tests is positive.