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Latent tuberculosis infection detection and active tuberculosis prevention in patients receiving anti‐ TNF therapy: an Italian nationwide survey
Author(s) -
Cantini Fabrizio,
Lubrano Ennio,
Marchesoni Antonio,
Mathieu Alessandro,
Olivieri Ignazio,
Salvarani Carlo,
Scarpa Raffaele,
Spadaro Antonio
Publication year - 2016
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.12708
Subject(s) - medicine , tuberculosis , latent tuberculosis , adalimumab , etanercept , isoniazid , incidence (geometry) , chest radiograph , quantiferon , population , rheumatology , mycobacterium tuberculosis , tumor necrosis factor alpha , pathology , lung , physics , environmental health , optics
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 + IGRA s 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.