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December 20, 2024Assessing latent tuberculosis infection prior to biologic therapy in psoriasis: a new diagnostic approach with an online interpreter
Metin Zuhal, Özyurt Kemal, Atasoy Mustafa,Yontar Efşan,Ertaş Ragıp,Görgülü Özkan,(2024).
Pamukkale Medical Journal, 17(1), 131-141., Doi: 10.31362/patd.1393540
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.