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Tuberculosis screening prior to anti‐tumor necrosis factor therapy among patients with immune‐mediated inflammatory diseases in Japan: a longitudinal study using a large‐scale health insurance claims database
- Source :
- International Journal of Rheumatic Diseases. 20:1674-1683
- Publication Year :
- 2017
- Publisher :
- Wiley, 2017.
-
Abstract
- Aim Tuberculosis screening is recommended for patients with immune-mediated inflammatory diseases (IMIDs) prior to anti-tumor necrosis factor (TNF) therapy. However, adherence to the recommended practice is unknown in the current clinical setting in Japan. Methods We used a large-scale health insurance claims database in Japan to conduct a longitudinal observational study. Of more than two million beneficiaries in the database between 2013 and 2014, we enrolled those with IMIDs aged 15–69 years who had initiated anti-TNF therapy. We defined tuberculosis screening primarily as tuberculin skin test and/or interferon-gamma release assay (TST/IGRA) within 2 months before commencing anti-TNF therapy. We analyzed the proportions of the patients who had undergone tuberculosis screening and the associations with primary disease, type of anti-TNF agent, methotrexate prescription prior to anti-TNF therapy, and treatment for latent tuberculosis infection (LTBI). Results Of 385 patients presumed to have initiated anti-TNF therapy, 252 (66%) had undergone tuberculosis screening by TST/IGRA (22% TST, 56% IGRA, and 12% both TST and IGRA), and 231 (60%) had undergone TST/IGRA and radiography. Patients with psoriasis tended to be more likely to undergo tuberculosis screening than those with other diseases; however, this association was not statistically significant. Treatment for LTBI was provided to 43 (11%) patients; 123 (32%) received neither TST/IGRA nor LTBI treatment. Conclusions Tuberculosis screening was often not performed prior to anti-TNF therapy despite the guidelines’ recommendations; thus, patients could be put at unnecessary risk of reactivation of tuberculosis.
- Subjects :
- Adult
Male
medicine.medical_specialty
Longitudinal study
Tuberculosis
Adolescent
Databases, Factual
Anti-Inflammatory Agents
Tuberculin
Young Adult
03 medical and health sciences
0302 clinical medicine
Japan
Rheumatology
Latent Tuberculosis
Predictive Value of Tests
Risk Factors
Psoriasis
Internal medicine
medicine
Humans
Mass Screening
Longitudinal Studies
030212 general & internal medicine
Practice Patterns, Physicians'
Medical prescription
Inflammation
030203 arthritis & rheumatology
Latent tuberculosis
Tuberculin Test
Tumor Necrosis Factor-alpha
business.industry
Middle Aged
bacterial infections and mycoses
medicine.disease
Anti-Tumor Necrosis Factor Therapy
Practice Guidelines as Topic
Physical therapy
Female
Immune-mediated inflammatory diseases
Guideline Adherence
business
Administrative Claims, Healthcare
Interferon-gamma Release Tests
Subjects
Details
- ISSN :
- 1756185X and 17561841
- Volume :
- 20
- Database :
- OpenAIRE
- Journal :
- International Journal of Rheumatic Diseases
- Accession number :
- edsair.doi.dedup.....bba9b33ef4ff6a41923ed7078f88764d