17 Oct Broken promises
Clinicians are faced with difficult decisions when assessing if patients with a low immunity should be offered treatment to prevent tuberculosis. Such treatment adds to treatment already taken and increases the risk of side effects. The decision has been difficult because there were no good tests available to select the patients with the highest risk for tuberculosis who would benefit most by the treatment.
New tests were heralded as a breakthrough in this clinical dilemma given their assumed superior performance to diagnose tuberculosis infection in patients with low immunity. They became quickly a part of routine practice without rigorous assessments of their value.
The current study shows that the promise of superior performance is broken. The new IGRA test perform as poorly as the old skin test to identify patients with low immunity at highest risk of tuberculosis.
The clinical dilemma has not been solved. Although both the new and the old test play a role in clinical management of patients with low immunity, clinical judgment with a broad risk-assessment remains the cornerstone of clinical care.