Latent tuberculosis infection detection and active tuberculosis prevention in patients receiving anti-TNF therapy : an Italian nationwide survey
© 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2016 |
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| Erschienen: |
2016 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:19 |
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| Enthalten in: |
International journal of rheumatic diseases - 19(2016), 8 vom: 07. Aug., Seite 799-805 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cantini, Fabrizio [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 12.06.2017 Date Revised 20.03.2019 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/1756-185X.12708 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM250859122 |
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| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
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| 100 | 1 | |a Cantini, Fabrizio |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Latent tuberculosis infection detection and active tuberculosis prevention in patients receiving anti-TNF therapy |b an Italian nationwide survey |
| 264 | 1 | |c 2016 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 12.06.2017 | ||
| 500 | |a Date Revised 20.03.2019 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a anti-TNF | |
| 650 | 4 | |a interferon-gamma release assays | |
| 650 | 4 | |a latent tuberculosis infection | |
| 650 | 4 | |a tuberculin skin test | |
| 650 | 4 | |a tuberculosis | |
| 650 | 7 | |a Antirheumatic Agents |2 NLM | |
| 650 | 7 | |a Antitubercular Agents |2 NLM | |
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| 650 | 7 | |a Adalimumab |2 NLM | |
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| 650 | 7 | |a Etanercept |2 NLM | |
| 650 | 7 | |a OP401G7OJC |2 NLM | |
| 700 | 1 | |a Lubrano, Ennio |e verfasserin |4 aut | |
| 700 | 1 | |a Marchesoni, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Mathieu, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Olivieri, Ignazio |e verfasserin |4 aut | |
| 700 | 1 | |a Salvarani, Carlo |e verfasserin |4 aut | |
| 700 | 1 | |a Scarpa, Raffaele |e verfasserin |4 aut | |
| 700 | 1 | |a Spadaro, Antonio |e verfasserin |4 aut | |
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