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( Saad Alrajhi ),( Pascale Germain ),( Myriam Martel ),( Peter Lakatos ),( Talat Bessissow ),( Talal Al-taweel ),( Waqqas Afif ) 대한장연구학회 2020 Intestinal Research Vol.18 No.3
Background/Aims: Latent tuberculosis screening is mandatory prior to initiating anti-tumor necrosis factor (anti-TNF) medications. Guidelines recommend interferon-gamma release assays (IGRA) as first line screening method for the general popula tion. Studies provided conflicting evidence on IGRA and tuberculin skin test (TST) performance in inflammatory bowel disease (IBD) patients. We assessed test concordance and the effects of immunosuppression on their performance in IBD patients. Methods: We searched MEDLINE, Embase and Cochrane databases (2011-2018) for studies testing TST and IGRA in IBD. Pri mary outcome was TST and IGRA concordance. Secondary outcomes were effects of immunosuppressive therapy on perfor mance. Immunosuppression defined as either steroids, thiopurine, methotrexate or cyclosporine use. We used the pooled ran dom effects model to adjust for heterogeneity analyzed using (I2-Q statistics). We compared the fixed model to exclude smaller study effects. Results: Sixteen studies (2,488 patients) were included. Pooled TST and IGRA concordance was 85% (95% con fidence interval [CI], 81%-88%; P=0.01). Effects of immunosuppression were reported in 8 studies (814 patients). The odds ratio of testing positive by IGRA decreased to 0.57 if immunosuppressed (95% CI, 0.31-1.03; P=0.06). The odds ratio of testing positive by TST if immunosuppressed was 1.14 (95% CI, 0.61-2.12; P=0.69). The fixed model yielded similar results, however the negative effect of immunosuppression on IGRA reached statistical significance (P=0.01). Conclusions: While concordance was 85% between TST and IGRA, the performance of IGRA seems to be negatively affected by immunosuppression. Given the importance of detecting latent tuberculosis prior to anti-TNF initiation, further randomized controlled trials comparing the per formance of TST and IGRA in IBD patients are needed. (Intest Res 2020;18:306-314)
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