Utility of Repeat Latent Tuberculosis Testing With QuantiFERON-TB Gold Test in Psoriasis Patients Treated With TNF-α Inhibitors The British Journal of Dermatology

TAKE-HOME MESSAGE

• This study evaluated the rate of conversion from negative to positive status in the QuantiFERON-TB Gold (QFT) test for latent tuberculosis infection in patients with psoriasis treated with TNF-α inhibitor therapy. Of the 570 patients with 1547 QFT test results, only 3 (0.53%) converted from negative to positive QFT status after starting TNF-α inhibitor therapy. All 3 patients had identifiable risk factors for tuberculosis infection.

• Other studies have shown similar low conversion rates for patients on TNF-α inhibitor therapy with initially negative QFT tests, suggesting that annual screening for latent tuberculosis infection may be a costly and unnecessary tool. A careful history during each visit could identify patients at high risk for tuberculosis exposure and in need of annual screening.

– Caitlyn Reed, MD

Written by

 

 

George Han MD, PhD

There are a number of situations in medicine where best practices and scientific inquiry take a back seat to old habits and outdated guidelines. According to this article, repeated testing for latent tuberculosis (TB) in low-risk populations is one such case. Such testing has very little utility and the costs of doing so should be considered when compared with the relatively low yield of regularly repeating such tests. False positives (leading to chest x-rays and potentially unwarranted treatment) and additional blood draws can occur, wasting money and time for the patient. However, it is noted that not only do practicing dermatologists regularly recheck for latent TB, it is actually integrated into the Medicare Merit-Based Incentive Payment System (MIPS) quality measures. Studies such as this may help to turn the tide and remove this unnecessary burden for patients and for the health system from a cost perspective.

Although it is outside the scope of this article, perhaps the first habit we may break is rechecking for latent TB when prescribing an IL-17 inhibitor or an IL-23 inhibitor. There is no requirement on the label to recheck for TB (a negative TB test is required only prior to initiating therapy), and, furthermore, there is no rationale to think that blocking these interleukins will cause reactivation of TB. Perhaps, eventually, a rational level of caution will prevail!

Abstract 

Risk of latent tuberculosis infection (LTBI) reactivation in psoriasis patients treated with TNF-α inhibitors (TNFIs) is well-known. Thus, some organizations, including the National Psoriasis Foundation, recommend serial LTBI testing in patients receiving long-term TNFI treatment. Additionally, annual LTBI screening has been incorporated into Medicare Merit-Based Incentive Payment Systems (MIPS) quality measures and will impact physician reimbursement.

The British Journal of Dermatology

Utility of Repeat Latent Tuberculosis Testing With QuantiFERON-TB Gold Test in Psoriasis Patients Treated With TNF-α Inhibitors at a Single U.S. Institution

Br J Dermatol 2019 Aug 27;[EPub Ahead of Print], J Ya, U Khanna, S Havele, AP Fernandez 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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