University of California - San Francisco - Division of Rheumatology, Department of Medicine, 3333 California St San Francisco, CA 94118, United States; Philip R. Lee Institute for Health Policy Research, University of California - San Francisco, 3333 California St San Francisco, CA 94118, United States; San Francisco VA Medical Center, 4150 Clement St 111R, San Francisco, CA 94121, United States.
University of California - San Francisco - Division of Rheumatology, Department of Medicine, 3333 California St San Francisco, CA 94118, United States.
Semin Arthritis Rheum. 2020 Dec;50(6):1542-1548. doi: 10.1016/j.semarthrit.2020.03.003. Epub 2020 Mar 19.
Immunosuppressant drugs can increase the risk of hepatitis B virus (HBV) and hepatitis C virus (HCV) and tuberculosis (TB) reactivation. Using the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) registry, we examined pre-treatment screening among new users of biologic or targeted synthetic disease modifying drugs (DMARDs).
Data, derived from RISE, included patients ≥ 18 years old who were new users of biologic or targeted synthetic DMARDs. We developed quality measures related to pre-treatment screening for HBV, HCV, and TB in addition to a "composite" measure for all applicable tests. We assessed patient-level screening rates, practice-level variation among practices reporting on ≥ 20 patients, and the frequency of positive results.
We included 26,802 patients across 213 rheumatology practices nationwide. Patients were 58 (14) years old, 75.9% female; 59.6% had rheumatoid arthritis, and TNFi were the most common index DMARDs (64.9%). Overall, 44.8% and 40.5% patients had any documented HBV or HCV screening, respectively, prior to the index date; 29.7% had TB screening in the year prior to drug start. Only 15.5% had documentation of screening for all appropriate infections prior to drug start. Practice-level performance on the composite measure was low (range 0 to 48.3%). 2.4% of screening tests were positive.
We found gaps in documentation of key safety measures among practices participating in RISE. Given the small but significant number of patients with active or latent infections that pose safety risks, developing standardized and reliable strategies to capture safety screening measures is paramount.
免疫抑制剂会增加乙型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和结核（TB）再激活的风险。我们利用美国风湿病学会的风湿病信息系统（RISE）登记处，检查了新使用生物制剂或靶向合成疾病修正药物（DMARD）的患者的治疗前筛查情况。
RISE 数据库的数据包括≥18 岁、新使用生物制剂或靶向合成 DMARD 的患者。我们制定了与 HBV、HCV 和 TB 治疗前筛查相关的质量指标，以及所有适用检测的“综合”指标。我们评估了患者层面的筛查率、报告患者数≥20 的实践层面的差异，以及阳性结果的频率。
我们纳入了全国 213 个风湿病实践中的 26802 名患者。患者的年龄为 58（14）岁，女性占 75.9%；59.6%患有类风湿关节炎，肿瘤坏死因子抑制剂（TNFi）是最常见的起始 DMARD（64.9%）。总体而言，分别有 44.8%和 40.5%的患者在索引日期前有任何记录的 HBV 或 HCV 筛查，29.7%在开始药物治疗前的一年中进行了 TB 筛查。只有 15.5%的患者在开始药物治疗前有所有适当感染筛查的记录。实践层面在综合指标上的表现较低（范围 0 至 48.3%）。2.4%的筛查检测呈阳性。
我们发现参与 RISE 的实践在关键安全措施的记录方面存在差距。鉴于存在具有安全风险的活动性或潜伏性感染的患者数量虽小但意义重大，制定标准化和可靠的策略来获取安全筛查措施至关重要。
