Florenzo Iannone1, Fabrizio Cantini, Giovanni Lapadula. 1. Address correspondence to Prof. Iannone, Interdisciplinary Department of Medicine, Rheumatology Unit, P.zza G. Cesare 11, 70124 Bari, Italy; E-mail: florenzo.iannone@uniba.it.
Abstract
OBJECTIVE: To review the official international recommendations on the management of latent tuberculosis infection (LTBI) in patients with rheumatic diseases undergoing biologic therapy. METHODS: A systematic search of all clinical practice recommendations on the diagnosis and treatment of LTBI in rheumatic patients eligible for starting biologic drugs published between January 2002 and March 2013. RESULTS: For the diagnosis of LTBI, based on positivity of tuberculin skin test (TST), interferon-γ release assay (IGRA) is also available. Most recommendations advise using both TST and IGRA, especially in case of Bacillus Calmette-Guérin vaccination, to screen patients before commencing biologic drugs. There is a general consensus that evaluation of the global risk of TB infection is a crucial point and that patients with LTBI must receive chemoprophylaxis prior to biologic therapy. However, recommendations on the need for rescreening for activation of LTBI or new TB infection while patients are being treated are inadequate. Nevertheless, the main concern is poor compliance with TB recommendations of rheumatologists in clinical practice, which seems to be the main cause of the occurrence of active TB in rheumatic patients receiving biologic therapy. CONCLUSION: Notwithstanding some differences, mainly related to regional TB incidence, international recommendations strongly suggest careful screening for LTBI before starting biologic therapy. However, the critical point is implementing dissemination and awareness of the recommendations among rheumatologists to improve adherence in real life.
OBJECTIVE: To review the official international recommendations on the management of latent tuberculosis infection (LTBI) in patients with rheumatic diseases undergoing biologic therapy. METHODS: A systematic search of all clinical practice recommendations on the diagnosis and treatment of LTBI in rheumaticpatients eligible for starting biologic drugs published between January 2002 and March 2013. RESULTS: For the diagnosis of LTBI, based on positivity of tuberculin skin test (TST), interferon-γ release assay (IGRA) is also available. Most recommendations advise using both TST and IGRA, especially in case of Bacillus Calmette-Guérin vaccination, to screen patients before commencing biologic drugs. There is a general consensus that evaluation of the global risk of TB infection is a crucial point and that patients with LTBI must receive chemoprophylaxis prior to biologic therapy. However, recommendations on the need for rescreening for activation of LTBI or new TB infection while patients are being treated are inadequate. Nevertheless, the main concern is poor compliance with TB recommendations of rheumatologists in clinical practice, which seems to be the main cause of the occurrence of active TB in rheumaticpatients receiving biologic therapy. CONCLUSION: Notwithstanding some differences, mainly related to regional TB incidence, international recommendations strongly suggest careful screening for LTBI before starting biologic therapy. However, the critical point is implementing dissemination and awareness of the recommendations among rheumatologists to improve adherence in real life.
Authors: Juan González-Moreno; Mercedes García-Gasalla; Inés Losada-López; Carmen Cifuentes Luna; Isabel Mir Viladrich; Victoria Fernández-Baca; Araceli Serrano; Antonio Juan Mas; Joan Riera-Oliver; Antoni Payeras Cifre Journal: Rheumatol Int Date: 2017-10-19 Impact factor: 2.631
Authors: Yi-Hsing Chen; Hellen Mds de Carvalho; Umut Kalyoncu; Lyndon John Q Llamado; Gaston Solano; Ron Pedersen; Galina Lukina; Juan J Lichauco; Radu S Vasilescu Journal: Biologics Date: 2018-01-12