switzerland abandons tb skin test

good old swiss,

Swiss experts recommend QuantiFERON®-TB Gold for tuberculosis infection screening prior to initiating anti-TNF-α therapy


Melbourne, Australia; 15th November, 2007– Swiss experts have abandoned the over 100
year old tuberculin skin test (TST) favouring the use of interferon-γ release assays such as
QuantiFERON®-TB Gold (QFT™) for screening patients for tuberculosis (TB) infection prior to
initiating biological treatments (such as anti-TNF-α therapy). In recommendations published in
the current issue of the Swiss Medical Weekly, experts advocate the use of QFTâ„¢ in place of
the TST, as it is more accurate (sensitive & specific) than the TST in individuals with immune
suppression and provides rapid and reproducible results. These recommendations come after
the recent approval of the In-Tube format of QFTâ„¢ by the U.S. Food and Drug Administration
(FDA) and its widespread use in Europe and Asia for a number of years.
Biological treatments (like anti-TNF-α) are increasingly being used to treat rheumatoid arthritis,
dermatological conditions like psoriasis and gastroenterological conditions like Crohn's disease
and ulcerative colitis. Patients receiving anti-TNF-α therapy are at a higher risk of developing
tuberculosis during treatment than patients with similar diseases not receiving anti-TNF-α
therapy or the general population. Most cases of TB appear due to reactivation of latent TB
infection and not new (or de novo) infection, and the Swiss recommendations advocate
screening all patients for TB infection prior to initiating anti-TNF-α therapy. In addition to QFT™
use, screening should be based on a detailed medical history and a chest x-ray.
Preventive treatment should be offered to all patients with evidence of latent tuberculosis
infection before starting anti-TNF-α therapy. For patients with a positive QFT™ result, the
experts unanimously supported appropriate preventive drug treatment for TB.
The group of experts (in rheumatology, gastroenterology & pneumology) published the
recommendations in the current issue of Swiss Medical Weekly, the official journal of the Swiss
Society of Infectious Diseases, the Swiss Society of Internal Medicine and the Swiss
Respiratory Society.