Latent tuberculosis infection detection and active tuberculosis prevention in patients receiving anti-TNF therapy: an Italian nationwide survey.

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.

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.

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).

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.

• Authors: Fabrizio Cantini, Ennio Lubrano, Antonio Marchesoni, Alessandro Mathieu, Ignazio Olivieri, Carlo Salvarani, Raffaele Scarpa, Antonio Spadaro
• Journal: International journal of rheumatic diseases (Int J Rheum Dis) Vol. 19 Issue 8 Pg. 799-805 (Aug 2016) ISSN: 1756-185X [Electronic] England
• PMID: 26172207 (Publication Type: Journal Article)
• Copyright: © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

Chemical References

• Antirheumatic Agents
• Antitubercular Agents
• Biological Products
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab
• Etanercept

Topics

• Adalimumab (adverse effects)
• Antirheumatic Agents (adverse effects)
• Antitubercular Agents (therapeutic use)
• Biological Products (adverse effects)
• Chi-Square Distribution
• Etanercept (adverse effects)
• Guideline Adherence
• Health Care Surveys
• Humans
• Immunocompromised Host
• Incidence
• Infliximab (adverse effects)
• Italy (epidemiology)
• Latent Tuberculosis (diagnosis, epidemiology, immunology)
• Opportunistic Infections (diagnosis, epidemiology, immunology, prevention & control)
• Practice Guidelines as Topic
• Practice Patterns, Physicians'
• Predictive Value of Tests
• Prognosis
• Rheumatic Diseases (diagnosis, drug therapy, epidemiology, immunology)
• Rheumatologists
• Risk Factors
• Time Factors
• Tuberculosis (diagnosis, epidemiology, immunology, prevention & control)
• Tumor Necrosis Factor-alpha (antagonists & inhibitors, immunology)