Hou Jason K, Kramer Jennifer R, Richardson Peter, Sansgiry Shubhada, El-Serag Hashem B
*Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; †Department of Medicine, Baylor College of Medicine, Houston, Texas; and ‡South Central Mental Illness Research Education and Clinical Center (MIRECC), Houston, Texas.
Inflamm Bowel Dis. 2017 Feb;23(2):254-260. doi: 10.1097/MIB.0000000000001003.
Tumor necrosis factor antagonists (anti-TNFs) are effective in treating inflammatory bowel disease (IBD) but may cause reactivation of tuberculosis (TB). TB screening rates and related outcomes are not well described among patients with IBD. This study aims to evaluate the prevalence and determinants of TB screening before anti-TNF initiation and related outcomes among patients with IBD.
We identified patients with IBD with filled prescriptions for anti-TNFs using the National Veterans Affairs administrative data sets. Determinants of TB screening were identified by univariate and multivariate analyses. Patients with TB reactivation were identified by ICD9 codes or prescriptions for isoniazid, and confirmed by chart review.
A total of 3357 patients with IBD were identified with filled anti-TNF prescriptions. Approximately 72% to 86% of patients received TB screening. In multivariate analyses, patients in rural areas were less likely to be screened for TB compared with those in urban areas (odds ratio 0.72, 95% confidence ratio 0.54-0.95). Patients who received care at academically affiliated facilities were more likely to have received screening for TB (odds ratio 1.49, 95% confidence ratio 1.31-1.95). In 7210 patient-years of follow-up on anti-TNF, TB reactivation was confirmed in 2 patients, both of whom had a history and treatment of latent TB before anti-TNF initiation.
TB screening before anti-TNF is estimated to be between 72% and 86%. Receipt of care at urban, academic-affiliated, high-volume IBD facilities is associated with higher rates of screening. Reactivation of TB in a highly screened cohort is estimated to be 2.8 per 10,000 patient-years.
肿瘤坏死因子拮抗剂（抗 TNF）在治疗炎症性肠病（IBD）方面有效，但可能导致结核病（TB）复发。IBD 患者的 TB 筛查率及相关结果尚无充分描述。本研究旨在评估 IBD 患者在开始使用抗 TNF 之前的 TB 筛查患病率及决定因素以及相关结果。
我们使用国家退伍军人事务管理数据集识别出有抗 TNF 处方的 IBD 患者。通过单因素和多因素分析确定 TB 筛查的决定因素。通过 ICD9 编码或异烟肼处方识别出 TB 复发患者，并通过病历审查进行确认。
共识别出 3357 例有抗 TNF 处方的 IBD 患者。约 72%至 86%的患者接受了 TB 筛查。在多因素分析中，与城市地区患者相比，农村地区患者接受 TB 筛查的可能性较小（比值比 0.72，95%置信比 0.54 - 0.95）。在学术附属机构接受治疗的患者接受 TB 筛查的可能性更大（比值比 1.49，95%置信比 1.31 - 1.95）。在对 7210 患者年的抗 TNF 随访中，2 例患者被确诊为 TB 复发，这 2 例患者在开始使用抗 TNF 之前均有潜伏性 TB 的病史和治疗史。
抗 TNF 治疗前的 TB 筛查率估计在 72%至 86%之间。在城市、学术附属、大量 IBD 患者就诊的机构接受治疗与更高的筛查率相关。在经过高度筛查的队列中，TB 复发率估计为每 10000 患者年 2.8 例。
