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Latent tuberculosis infection detection and active tuberculosis prevention in patients receiving anti-TNF therapy: an Italian nationwide survey.
- Source :
-
International journal of rheumatic diseases [Int J Rheum Dis] 2016 Aug; Vol. 19 (8), pp. 799-805. Date of Electronic Publication: 2015 Jul 14. - Publication Year :
- 2016
-
Abstract
- Aims: Primary: to investigate Italian rheumatology practice regarding latent tubercular infection (LTBI) detection and tuberculosis (TB) prevention in patients requiring anti-tumor necrosis factor (anti-TNF) therapy. Secondary: to assess the overall number of TB cases over 10 years and their distribution by drug.<br />Methods: An anonymous, 24 multiple-response questionnaire was completed by 393/449 (87.5%) rheumatologists prescribing anti-TNF therapy. Six questions provided setting information, and 18 the compliance with recommendations and the recorded TB cases.<br />Results: The Italian recommendations were used by 323 (82%) and other sets by 60 (15%). TB specialists were always consulted by 81 (21%) and occasionally by 73 (19%). LTBI screening was made using chest radiograph (CR) by 5%, tuburculin skin test (TST) by 5.3%, CR + TST by 35.6%, interferon-gamma release assay (IGRA) by 7.4%, CR + IGRAs by 26% and CR + TST + IGRA by 20.6%. Isoniazid was initiated in the presence of positivity of TST by 97 (24.7%), TST + IGRA by 101 (25.7%) and IGRA by 195 (49.6%). Anti-TNF starting delay was 1 month in 63.1% of the cases, 3 months in 27.7%, concomitantly in 5.6%. Overall, 317 TB reactivation cases occurred in 39 353 patients, with an incidence rate of 80.5 cases/100 000/year (10 times higher than in the Italian general population). TB occurred during TB prophylaxis in 192 (60.6%). TB cases incidence rate divided by drug was: etanercept (ETN) 51 (16%), 28/100 000/year, adalimumab (ADA) 98 (31%), 89/100 000/year, infliximab (IFX) 137 (43.2%), 211/100 000/year, with a significantly lower frequency in the ETN group compared to ADA and IFX groups (χ(2)  = P < 0.001).<br />Conclusion: Italian rheumatologists are highly aware of anti-TNF-related TB risk with variable LTBI screening and TB prevention strategies. TB outcome was significantly lower in the ETN group.<br /> (© 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)
- Subjects :
- Adalimumab adverse effects
Antitubercular Agents therapeutic use
Chi-Square Distribution
Etanercept adverse effects
Guideline Adherence
Health Care Surveys
Humans
Incidence
Infliximab adverse effects
Italy epidemiology
Latent Tuberculosis diagnosis
Latent Tuberculosis epidemiology
Opportunistic Infections diagnosis
Opportunistic Infections epidemiology
Opportunistic Infections prevention & control
Practice Guidelines as Topic
Practice Patterns, Physicians'
Predictive Value of Tests
Prognosis
Rheumatic Diseases diagnosis
Rheumatic Diseases epidemiology
Rheumatic Diseases immunology
Risk Factors
Time Factors
Tuberculosis diagnosis
Tuberculosis epidemiology
Tuberculosis prevention & control
Tumor Necrosis Factor-alpha immunology
Antirheumatic Agents adverse effects
Biological Products adverse effects
Immunocompromised Host
Latent Tuberculosis immunology
Opportunistic Infections immunology
Rheumatic Diseases drug therapy
Rheumatologists
Tuberculosis immunology
Tumor Necrosis Factor-alpha antagonists & inhibitors
Subjects
Details
- Language :
- English
- ISSN :
- 1756-185X
- Volume :
- 19
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- International journal of rheumatic diseases
- Publication Type :
- Academic Journal
- Accession number :
- 26172207
- Full Text :
- https://doi.org/10.1111/1756-185X.12708