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Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Screening for latent tuberculosis infection (LTBI) is mandatory before commencing tumor necrosis factor (TNF)-α inhibitor use. However, the impact of immunosuppressive therapy (IST), including corticosteroids and immunomodulators, on the performance of LTBI screening in patients with inflammatory bo...

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Autores principales: Park, Chan Hyuk, Park, Jung Ho, Jung, Yoon Suk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8953543/
https://www.ncbi.nlm.nih.gov/pubmed/35330505
http://dx.doi.org/10.3390/jpm12030507
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author Park, Chan Hyuk
Park, Jung Ho
Jung, Yoon Suk
author_facet Park, Chan Hyuk
Park, Jung Ho
Jung, Yoon Suk
author_sort Park, Chan Hyuk
collection PubMed
description Screening for latent tuberculosis infection (LTBI) is mandatory before commencing tumor necrosis factor (TNF)-α inhibitor use. However, the impact of immunosuppressive therapy (IST), including corticosteroids and immunomodulators, on the performance of LTBI screening in patients with inflammatory bowel disease (IBD) has not been fully elucidated. We searched all relevant studies published before November 2021 that examined the performance of interferon γ release assays (IGRAs) and tuberculin skin tests (TSTs) in patients with IBD who received IST, using the Medline, EMBASE, and Cochrane Library databases. We performed meta-analyses of positive or indeterminate rates of IGRA or TST according to IST and calculated the concordance rates between IGRA and TST results. A total of 20 studies with 4045 patients were included in the meta-analysis. The IGRA-positive rate was lower in patients on IST than in those not on IST (odds ratio (OR) (95% confidence interval (CI)) = 0.55 (0.39–0.78)), whereas the IGRA-indeterminate rate was higher in patients on IST than in those not on IST (OR (95% CI) = 2.91 (1.36–6.24)). The TST-positive rate did not differ between the on-IST and not-on-IST groups (OR (95% CI) = 0.87 (0.51–1.50)). The concordance rate between IGRA and TST was 83.3% (95% CI, 78.5–88.1%). The IGRA-negative/TST-positive rate tended to be higher than that the IGRA-positive/TST-negative rate (9.5% vs. 5.8%, respectively), although the difference was not statistically significant. In conclusion, IGRA results were negatively affected by IST in patients with IBD, supporting requirements that IGRA should be performed before initiating IST. The use of both an IGRA and TST in patients with IBD on IST may improve the diagnosis rate of LTBI.
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spelling pubmed-89535432022-03-26 Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis Park, Chan Hyuk Park, Jung Ho Jung, Yoon Suk J Pers Med Systematic Review Screening for latent tuberculosis infection (LTBI) is mandatory before commencing tumor necrosis factor (TNF)-α inhibitor use. However, the impact of immunosuppressive therapy (IST), including corticosteroids and immunomodulators, on the performance of LTBI screening in patients with inflammatory bowel disease (IBD) has not been fully elucidated. We searched all relevant studies published before November 2021 that examined the performance of interferon γ release assays (IGRAs) and tuberculin skin tests (TSTs) in patients with IBD who received IST, using the Medline, EMBASE, and Cochrane Library databases. We performed meta-analyses of positive or indeterminate rates of IGRA or TST according to IST and calculated the concordance rates between IGRA and TST results. A total of 20 studies with 4045 patients were included in the meta-analysis. The IGRA-positive rate was lower in patients on IST than in those not on IST (odds ratio (OR) (95% confidence interval (CI)) = 0.55 (0.39–0.78)), whereas the IGRA-indeterminate rate was higher in patients on IST than in those not on IST (OR (95% CI) = 2.91 (1.36–6.24)). The TST-positive rate did not differ between the on-IST and not-on-IST groups (OR (95% CI) = 0.87 (0.51–1.50)). The concordance rate between IGRA and TST was 83.3% (95% CI, 78.5–88.1%). The IGRA-negative/TST-positive rate tended to be higher than that the IGRA-positive/TST-negative rate (9.5% vs. 5.8%, respectively), although the difference was not statistically significant. In conclusion, IGRA results were negatively affected by IST in patients with IBD, supporting requirements that IGRA should be performed before initiating IST. The use of both an IGRA and TST in patients with IBD on IST may improve the diagnosis rate of LTBI. MDPI 2022-03-21 /pmc/articles/PMC8953543/ /pubmed/35330505 http://dx.doi.org/10.3390/jpm12030507 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Park, Chan Hyuk
Park, Jung Ho
Jung, Yoon Suk
Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
title Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
title_full Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
title_fullStr Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
title_full_unstemmed Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
title_short Impact of Immunosuppressive Therapy on the Performance of Latent Tuberculosis Screening Tests in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis
title_sort impact of immunosuppressive therapy on the performance of latent tuberculosis screening tests in patients with inflammatory bowel disease: a systematic review and meta-analysis
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8953543/
https://www.ncbi.nlm.nih.gov/pubmed/35330505
http://dx.doi.org/10.3390/jpm12030507
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