Do the drug doses of conventional synthetic DMARDs used for the treatment of biologic/targeted-synthetic DMARDs naive rheumatoid arthritis patients affect QuantiFERON-TB Gold Plus test results?

• Published in: Rheumatology international Vol. 43; no. 8; pp. 1445 - 1451
• Main Authors: Ozsoy, Zehra, Ozdemir, Adem, Ekici, Mustafa, Bilgin, Emre, Kılıc, Levent, Kiraz, Sedat, Sarıbas, Zeynep, Sener, Burçin, Karadag, Omer
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-08-2023; Springer Nature B.V
• Subjects: Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Biological Products - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Interferon-gamma Release Tests - methods; Latent Tuberculosis - drug therapy; Medicine; Medicine & Public Health; Observational Research; Rheumatoid arthritis; Rheumatology; Tuberculin Test - methods; Tuberculosis; Tuberculosis - drug therapy; Immunosuppressive drugs; Interferon-gamma release assays; Biologic/targeted-synthetic disease modifying anti-rheumatismal drugs; Latent tuberculosis reactivation; Rheumatoid arthritis; QuantiFERON-TB Gold Plus
• ISSN: 1437-160X; 0172-8172; 1437-160X
• DOI: 10.1007/s00296-023-05320-7

We aimed to obtain the effects of immunosuppressive doses on the QuantiFERON-TB Gold Plus (QFT-Plus) test results in Rheumatoid Arthritis (RA) patients. Besides this, the impact of the TB2 tube in QFT-Plus test was also investigated. This study included RA patients registered to HURBIO and were screened via QFT-Plus test for latent tuberculosis between January 2018 and March 2021, before the initiation of treatment of biologic/targeted-synthetic disease modifying anti-rheumatismal drugs (b/ts-DMARDs). Patients using methotrexate ≥ 10 mg or leflunomide (any dose) or steroids (≥ 7.5 mg prednisolone) at the time of QFT-Plus test were classified as the “high dose” group and the rest of the patients constituted the “low dose” group. The study included 534 RA patients; 353 [66.1%] in the high-dose group and 181 [33.9%] in the low-dose group. While QFT-Plus test was positive in 10.5% (37/353) patients in the high-dose group, it was positive in 20.4% (37/181) patients in the low-dose group (
p
 < 0.001). The percentage of QFT-Plus indeterminate results were similar (around 2%) in both groups. The contribution of the TB2 tube to QFT-Plus test positivity was 6.89%. During a median (inter-quartile range) follow-up period of 23 (7–38) months under treatment of b/ts-DMARDs, latent TB reactivation was not observed. Primer active tuberculosis disease developed in two patients. Positive test results of Interferon-Gamma Release Assays (IGRAs) could decrease as immunosuppressive treatment doses increase in patients with RA and addition of the TB2 tube could increase test sensitivity.