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Effect of immunosuppressive therapy on interferon γ release assay for latent tuberculosis screening in patients with autoimmune diseases: a systematic review and meta-analysis

ObjectiveInterferon γ release assay (IGRA) is commonly used to diagnose latent TB infection (LTBI). Immunosuppressive therapy may affect its performance but data are conflicting. We aimed to determine the effect of immunosuppressive therapy on the performance of IGRA in patients with autoimmune dise... Full description

Journal Title: Thorax 2016-01, Vol.71 (1), p.64-72
Main Author: Wong, Sunny H
Other Authors: Gao, Qinyan , Tsoi, Kelvin K F , Wu, William K K , Tam, Lai-shan , Lee, Nelson , Chan, Francis K L , Wu, Justin C Y , Sung, Joseph J Y , Ng, Siew C
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: England: British Medical Association
ID: ISSN: 0040-6376
Link: https://www.ncbi.nlm.nih.gov/pubmed/26659461
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recordid: cdi_proquest_miscellaneous_1827882576
title: Effect of immunosuppressive therapy on interferon γ release assay for latent tuberculosis screening in patients with autoimmune diseases: a systematic review and meta-analysis
format: Article
creator:
  • Wong, Sunny H
  • Gao, Qinyan
  • Tsoi, Kelvin K F
  • Wu, William K K
  • Tam, Lai-shan
  • Lee, Nelson
  • Chan, Francis K L
  • Wu, Justin C Y
  • Sung, Joseph J Y
  • Ng, Siew C
subjects:
  • Autoimmune Diseases - complications
  • Autoimmune Diseases - drug therapy
  • Care and treatment
  • Dosage and administration
  • Humans
  • Immunosuppressive agents
  • Immunosuppressive Agents - therapeutic use
  • Interferon gamma
  • Interferon-gamma Release Tests
  • Latent Tuberculosis - diagnosis
  • Meta-analysis
  • Mycobacterium
  • Tuberculosis
  • Usage
ispartof: Thorax, 2016-01, Vol.71 (1), p.64-72
description: ObjectiveInterferon γ release assay (IGRA) is commonly used to diagnose latent TB infection (LTBI). Immunosuppressive therapy may affect its performance but data are conflicting. We aimed to determine the effect of immunosuppressive therapy on the performance of IGRA in patients with autoimmune diseases.MethodsWe searched PubMed, MEDLINE, EMBASE and the Cochrane Library up to December 2014. We included studies that reported the IGRA results in patients with autoimmune disease with or without immunosuppressive therapy. The pooled effect of immunosuppressive therapy on IGRA was estimated using a Peto fixed-effects model.ResultsWe included 17 studies with 3197 participants in the meta-analysis. Among the subjects, 71.5% were taking immunosuppressive therapy and 56.7% had received Bacillus Calmette–Guérin vaccination. Compared with patients not on immunosuppressants, patients receiving immunosuppressive therapy were less likely to have a positive IGRA result (OR 0.66, 95% CI 0.53 to 0.83, I2=23%), especially patients receiving anti-tumour necrosis factor (anti-TNF) treatment (OR 0.50, 95% CI 0.29 to 0.88). The use of immunosuppressive therapy was also associated with a lower rate of positive tuberculin skin test result (OR 0.51, 95% CI 0.42 to 0.61).ConclusionsOur meta-analysis showed that IGRA results are negatively affected by immunosuppressive therapy. IGRA alone may not be sufficiently sensitive to diagnose LTBI in patients on immunosuppressive therapy. Patients should preferably be screened for LTBI before initiation of immunosuppressive therapy, especially before anti-TNF therapy.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0040-6376
fulltext: fulltext
issn:
  • 0040-6376
  • 1468-3296
url: Link


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titleEffect of immunosuppressive therapy on interferon γ release assay for latent tuberculosis screening in patients with autoimmune diseases: a systematic review and meta-analysis
sourceAlma/SFX Local Collection
creatorWong, Sunny H ; Gao, Qinyan ; Tsoi, Kelvin K F ; Wu, William K K ; Tam, Lai-shan ; Lee, Nelson ; Chan, Francis K L ; Wu, Justin C Y ; Sung, Joseph J Y ; Ng, Siew C
creatorcontribWong, Sunny H ; Gao, Qinyan ; Tsoi, Kelvin K F ; Wu, William K K ; Tam, Lai-shan ; Lee, Nelson ; Chan, Francis K L ; Wu, Justin C Y ; Sung, Joseph J Y ; Ng, Siew C
descriptionObjectiveInterferon γ release assay (IGRA) is commonly used to diagnose latent TB infection (LTBI). Immunosuppressive therapy may affect its performance but data are conflicting. We aimed to determine the effect of immunosuppressive therapy on the performance of IGRA in patients with autoimmune diseases.MethodsWe searched PubMed, MEDLINE, EMBASE and the Cochrane Library up to December 2014. We included studies that reported the IGRA results in patients with autoimmune disease with or without immunosuppressive therapy. The pooled effect of immunosuppressive therapy on IGRA was estimated using a Peto fixed-effects model.ResultsWe included 17 studies with 3197 participants in the meta-analysis. Among the subjects, 71.5% were taking immunosuppressive therapy and 56.7% had received Bacillus Calmette–Guérin vaccination. Compared with patients not on immunosuppressants, patients receiving immunosuppressive therapy were less likely to have a positive IGRA result (OR 0.66, 95% CI 0.53 to 0.83, I2=23%), especially patients receiving anti-tumour necrosis factor (anti-TNF) treatment (OR 0.50, 95% CI 0.29 to 0.88). The use of immunosuppressive therapy was also associated with a lower rate of positive tuberculin skin test result (OR 0.51, 95% CI 0.42 to 0.61).ConclusionsOur meta-analysis showed that IGRA results are negatively affected by immunosuppressive therapy. IGRA alone may not be sufficiently sensitive to diagnose LTBI in patients on immunosuppressive therapy. Patients should preferably be screened for LTBI before initiation of immunosuppressive therapy, especially before anti-TNF therapy.
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subjectAutoimmune Diseases - complications ; Autoimmune Diseases - drug therapy ; Care and treatment ; Dosage and administration ; Humans ; Immunosuppressive agents ; Immunosuppressive Agents - therapeutic use ; Interferon gamma ; Interferon-gamma Release Tests ; Latent Tuberculosis - diagnosis ; Meta-analysis ; Mycobacterium ; Tuberculosis ; Usage
ispartofThorax, 2016-01, Vol.71 (1), p.64-72
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descriptionObjectiveInterferon γ release assay (IGRA) is commonly used to diagnose latent TB infection (LTBI). Immunosuppressive therapy may affect its performance but data are conflicting. We aimed to determine the effect of immunosuppressive therapy on the performance of IGRA in patients with autoimmune diseases.MethodsWe searched PubMed, MEDLINE, EMBASE and the Cochrane Library up to December 2014. We included studies that reported the IGRA results in patients with autoimmune disease with or without immunosuppressive therapy. The pooled effect of immunosuppressive therapy on IGRA was estimated using a Peto fixed-effects model.ResultsWe included 17 studies with 3197 participants in the meta-analysis. Among the subjects, 71.5% were taking immunosuppressive therapy and 56.7% had received Bacillus Calmette–Guérin vaccination. Compared with patients not on immunosuppressants, patients receiving immunosuppressive therapy were less likely to have a positive IGRA result (OR 0.66, 95% CI 0.53 to 0.83, I2=23%), especially patients receiving anti-tumour necrosis factor (anti-TNF) treatment (OR 0.50, 95% CI 0.29 to 0.88). The use of immunosuppressive therapy was also associated with a lower rate of positive tuberculin skin test result (OR 0.51, 95% CI 0.42 to 0.61).ConclusionsOur meta-analysis showed that IGRA results are negatively affected by immunosuppressive therapy. IGRA alone may not be sufficiently sensitive to diagnose LTBI in patients on immunosuppressive therapy. Patients should preferably be screened for LTBI before initiation of immunosuppressive therapy, especially before anti-TNF therapy.
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titleEffect of immunosuppressive therapy on interferon γ release assay for latent tuberculosis screening in patients with autoimmune diseases: a systematic review and meta-analysis
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abstractObjectiveInterferon γ release assay (IGRA) is commonly used to diagnose latent TB infection (LTBI). Immunosuppressive therapy may affect its performance but data are conflicting. We aimed to determine the effect of immunosuppressive therapy on the performance of IGRA in patients with autoimmune diseases.MethodsWe searched PubMed, MEDLINE, EMBASE and the Cochrane Library up to December 2014. We included studies that reported the IGRA results in patients with autoimmune disease with or without immunosuppressive therapy. The pooled effect of immunosuppressive therapy on IGRA was estimated using a Peto fixed-effects model.ResultsWe included 17 studies with 3197 participants in the meta-analysis. Among the subjects, 71.5% were taking immunosuppressive therapy and 56.7% had received Bacillus Calmette–Guérin vaccination. Compared with patients not on immunosuppressants, patients receiving immunosuppressive therapy were less likely to have a positive IGRA result (OR 0.66, 95% CI 0.53 to 0.83, I2=23%), especially patients receiving anti-tumour necrosis factor (anti-TNF) treatment (OR 0.50, 95% CI 0.29 to 0.88). The use of immunosuppressive therapy was also associated with a lower rate of positive tuberculin skin test result (OR 0.51, 95% CI 0.42 to 0.61).ConclusionsOur meta-analysis showed that IGRA results are negatively affected by immunosuppressive therapy. IGRA alone may not be sufficiently sensitive to diagnose LTBI in patients on immunosuppressive therapy. Patients should preferably be screened for LTBI before initiation of immunosuppressive therapy, especially before anti-TNF therapy.
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