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Published on: August 16, 2021
Screening for Latent Tuberculosis Infection in Patients who are Candidate for Biological Therapies in Spain? A
Sarai Quirós1, David de la Rosa2, Ane Uranga3
1Servicio de Neumología, Hospital General Universitario La Paz-Carlos III- Cantoblanco, Madrid, España.
Introduction:
Treatment with biological therapies increases the incidence of tuberculous disease. The introduction of systematic screening for latent tuberculosis infection in patients who are to receive these therapies has reduced this risk. In 2016, the consensus document on the prevention and treatment of tuberculosis in patients who are candidates for biological treatment was published in Spain. The main objective of this study was to evaluate adherence to these guidelines.
Methods:
Multicenter, descriptive, observational study via an anonymous online survey sent to medical societies involved in biologics.
Results:
We received 747 responses. Most respondents performed screening at the right time in the right patients (93.7%). Only 36.6% of respondents requested the appropriate diagnostic test, while 56.3% correctly recommended chemoprophylaxis. Up to 96% were familiar with the recommended chemoprophylaxis regimens, while only 63.9% initiated them at the right time. The specialist area that participated most and screened most patients for latent tuberculosis infection was rheumatology (54%). In most cases, pulmonologists were involved in an advisory capacity.
Conclusions:
This study shows poor overall adherence to recommendations, with only 56% of respondents reporting appropriate compliance. The incidence of tuberculous disease in patients who are to receive biological therapies could be reduced further by emphasizing the importance of the right diagnostic test and use of the diagnostic algorithm for latent tuberculosis infection.
Insights
Adherence to tuberculosis screening guidelines for patients on biological therapies is suboptimal. Improving diagnostic test use and algorithm adherence can further reduce tuberculous disease incidence in this population.
Area of Science:
- Infectious Diseases
- Rheumatology
- Pulmonology
Background:
- Biological therapies increase tuberculosis risk.
- Systematic screening for latent tuberculosis infection (LTBI) mitigates this risk.
- Spanish guidelines for TB prevention in biologic candidates were published in 2016.
Purpose of the Study:
- To evaluate adherence to 2016 Spanish guidelines for TB prevention in patients receiving biological therapies.
- Assess the implementation of LTBI screening and chemoprophylaxis.
Main Methods:
- Multicenter, descriptive, observational study.
- Anonymous online survey distributed to medical societies involved in biologics.
- Analysis of 747 responses regarding screening practices and guideline adherence.
Main Results:
- High screening rates (93.7%) but low appropriate diagnostic test use (36.6%).
- Moderate chemoprophylaxis recommendation (56.3%) and initiation timing (63.9%).
- Rheumatology was the most active specialty in screening (54%); pulmonologists advised.
Conclusions:
- Overall adherence to TB prevention guidelines is poor (56%).
- Emphasizing correct diagnostic testing and algorithm use is crucial.
- Further reduction in tuberculous disease incidence is achievable with improved adherence.
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