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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?

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Abstract

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.

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Funding

No specific funding was received from any bodies in the public, commercial, or not-for-profit sectors to carry out the work described in this article.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Zehra Ozsoy, Mustafa Ekici, Emre Bilgin, Levent Kılıc, Sedat Kiraz & Omer Karadag

  2. Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey

    Adem Ozdemir, Zeynep Sarıbas & Burçin Sener

Authors
  1. Zehra Ozsoy
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  2. Adem Ozdemir
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  3. Mustafa Ekici
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  4. Emre Bilgin
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  6. Sedat Kiraz
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  7. Zeynep Sarıbas
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Contributions

Conceived and designed the analysis: ZO, AO, ME, EB, LK, SK, ZS, BŞ, and OK. Collected the data: ZO, AO, ME, EB, LK, SK, ZS, BŞ, and OK. Contributed data or analysis tools: ZO, AO, ME, EB, LK, SK, ZS, BŞ, and OK. Performed the analysis: ZO, AO, ME, EB, LK, SK, ZS, BŞ, and OK. Wrote the paper: ZO, AO, ME, EB, LK, SK, ZS, BŞ, and OK. Other contribution: ZO, AO, ME, EB, LK, SK, ZS, BŞ, and OK.

Corresponding author

Correspondence to Zehra Ozsoy.

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Conflict of Interest

EB received honorary from AbbVie, Novartis, and UCB-Pharma. SK received honorary from AbbVie, Amgen, Johnson, and Johnson, MSD, Novartis, Pfizer, Roche, and UCB-Pharma. OK received honorary from AbbVie, Aristea, Roche, Novartis, Viela-Bio, Zenas Biopharma, Abdi İbrahim, Celltrion, UCB-Pharma, and Menarini. All of the other authors have declared no conflicts of interest.

Ethics approval

Ethical approval was obtained from Hacettepe University Institutional Review Board (GO21/595, 04/05/2021).

Consent to participate

Written informed consent was obtained from each patient regarding the use of clinical data for research purposes. The study was in accordance with the 2013 amendment of the Helsinki declaration.

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Ozsoy, Z., Ozdemir, A., Ekici, M. et al. 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?. Rheumatol Int 43, 1445–1451 (2023). https://doi.org/10.1007/s00296-023-05320-7

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