Quantiferon en la detección de TB en Pacientes con Psoriasis y en tx con anti-tnf

Published in Dermatology

Journal Scan / Research · November 27, 2019

Utility of Repeat Latent Tuberculosis Testing With the QuantiFERON-TB Gold Test in Patients With Psoriasis Treated With TNF-α Inhibitors

The British Journal of Dermatology

TAKE-HOME MESSAGE

• In this single-center retrospective study of 570 patients with psoriasis treated with tumor necrosis factor‐α inhibitors (TNFIs), 1547 QuantiFERON-TB Gold tests (QFT) were performed (median, two tests per patient). A total of 3 patients (0.5%) converted from negative to positive QFT status after initiation of TNFIs and all had risk factors for tuberculosis. Only 1 of these was considered a true converter and treated for latent tuberculosis.

• The clinical value and cost-effectiveness of routine serial latent tuberculosis infection testing in patients already on TNFIs who live in low-risk areas and have no known risk factors is questionable. Serial screening may be better focused on a subset of patients with psoriasis with pertinent tuberculosis risk factors, which can be assessed by a comprehensive history at each follow-up visit.

– Caroline K. Crabtree, MD

 Dermatology

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Robert T Brodell MD, FAAD

This article provides yet another example of third-party payers micromanaging patient care. Several months ago, I decided to forgo annual tuberculosis testing in patients on biologics who were not in high-risk groups. My staff soon informed me that I was required by third-party payers to perform this testing to access the drugs for my patients! The American Academy of Dermatology will need to weigh in…if we are to save millions of dollars for the very insurance companies who are slow to react to new knowledge.

Abstract

The risk of latent tuberculosis (TB) infection(LTBI) reactivation in patients with psoriasis treated withtumour necrosis factor-a inhibitors (TNFIs) is well known.1Some organizations, including the National Psoriasis Founda-tion, recommend serial LTBI testing in patients receiving long-term TNFI treatment.2Additionally, annual LTBI screening hasbeen incorporated into Medicare Merit-Based Incentive Pay-ment Systems quality measures and will affect physician reim-bursement.3Thus, most physicians prescribing TNFIs willroutinely order annual LTBI testing for patients.4Furthermore,some insurance companies require annual LTBI screening forTNFI approval. However, there are limited data suggestingserial LTBI testing in patients taking TNFIs is cost-effective andwarranted for optimizing patient outcomes, especially in low-risk TB countries like the U.S.A. Our experience is that routineserial LTBI testing in patients with psoriasis taking TNFIs is oflittle clinical value. Here we review the incidence of conver-sion to positive LTBI testing in patients with psoriasis treatedwith TNFIs at our institution.

The British Journal of Dermatology

Utility of Repeat Latent Tuberculosis Testing With the QuantiFERON-TB Gold Test in Patients With Psoriasis Treated With Tumour Necrosis Factor-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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