Maeda Tetsuro, Connolly Margaret, Thevenet-Morrison Kelly, Levy Paul, Utell Mark, Munsiff Sonal, Croft Daniel
Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, United States.
Division of Infectious Diseases, University of Rochester Medical Center, United States.
J Clin Tuberc Other Mycobact Dis. 2024 Jun 22;36:100460. doi: 10.1016/j.jctube.2024.100460. eCollection 2024 Aug.
Biologic medications for immune-mediated inflammatory diseases may increase the risk of tuberculosis (TB) reactivation, but data on screening for TB in low TB prevalence areas are limited.
To assess the real-world practice patterns of TB screening among prescribers of biologic medications.
We conducted a retrospective observational study at a single, university-based healthcare facility in a low TB prevalence area. We enrolled adult patients prescribed a biologic medication between October 2018 and December 2021, and collected data on demographics, biologic medications and TB test results. For patients with positive TB tests, further data including prescriber specialty and response to positive tests were obtained. We reviewed pertinent major society guidelines/ consensus statements regarding TB screening among patients treated with biologic medications.
4,085 patients were included. 3024 (74.0%) had at least one screening TB test and 42 were positive. Among patients treated with tumor necrosis factor-alpha (TNFα) inhibitors, 1779 of 2129 patients (83.6%) underwent TB testing and 25 (1.4%) were positive. Most with positive TB test results were prescribed biologic medication by gastroenterology (11 patients, 26%), dermatology (12, 29%), or rheumatology (15, 36%) providers. 32 (76%) patients had imaging and roughly half were treated for latent TB infection. Biologic medications were temporarily held for 27 patients (67%). Nine out of 13 society guidelines recommend TB screening for TNFα inhibitors but have differing recommendations for other biologic medications.
Significant practice pattern differences in TB screening for patients receiving biologic medications exist. Multiple society guidelines continue to recommend TB screening even for drugs with no known increased risk of TB reactivation.
用于免疫介导的炎症性疾病的生物药物可能会增加结核病（TB）复发的风险，但在结核病低流行地区进行结核病筛查的数据有限。
评估生物药物处方者进行结核病筛查的实际操作模式。
我们在一个结核病低流行地区的单一大学医疗保健机构进行了一项回顾性观察研究。我们纳入了2018年10月至2021年12月期间开具生物药物处方的成年患者，并收集了人口统计学、生物药物和结核病检测结果的数据。对于结核病检测呈阳性的患者，获取了包括处方者专业和对阳性检测结果的反应等进一步数据。我们回顾了关于生物药物治疗患者结核病筛查的相关主要学会指南/共识声明。
共纳入4085例患者。3024例（74.0%）至少进行了一次结核病筛查，42例呈阳性。在接受肿瘤坏死因子-α（TNFα）抑制剂治疗的患者中，2129例患者中有1779例（83.6%）进行了结核病检测，25例（1.4%）呈阳性。大多数结核病检测结果呈阳性的患者由胃肠病学（11例患者，26%）、皮肤科（12例，29%）或风湿病学（15例，36%）医生开具生物药物。32例（76%）患者进行了影像学检查，约一半接受了潜伏性结核感染治疗。27例患者（67%）的生物药物被暂时停用。13项学会指南中有9项建议对TNFα抑制剂进行结核病筛查，但对其他生物药物有不同的建议。
接受生物药物治疗的患者在结核病筛查方面存在显著的实际操作模式差异。即使对于没有已知结核病复发风险增加的药物，多个学会指南仍继续建议进行结核病筛查。
