Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Infection is one of the most devastating side effects of biologic agents use, particularly early on in the course of therapy. Prevention is considered to be more important than treatment, especially in patients with known risk factors. Quality indicators (QI) has been received an increasing attention in rheumatology field and several guidelines for the prevention of biologic agents-related infections have been published, and they recommended the screening tests for hepatitis, latent tuberculosis infection (LTBI), and pneumocystis pneumonia (PCP) before starting biologic agents. However, few studies have reported the status of the implementation as well as interventions to improve its adherence in clinical settings. Herein, we repot the efficacy of monitoring for the improvement of LTBI QI for the use of biologic agents in the treatment of rheumatic disease.
Methods: We studied retrospectively all patients who had received biologic agents (TNF and non-TNF agents) for the treatment of rheumatic diseases in our department. To evaluate the adherence of a minimal standard of care for the pre-administration screening for LTBI, we monitored a LTBI bundle (chest image, tuberculosis skin test [TST] or INH prophylaxis, and interferon-gamma-release assays [IGRAs]). Since 2010, we had started a LTBI bundle for the use of biologic agents in the treatment of rheumatic disease and clinical date from January 2007 to December 2014 were collected to evaluate the proportion. In addition, we also evaluated the results of follow-up IGRA for detection of latent and newly developing tuberculosis.
Results: We identified 342 eligible patients. The analysis of data showed increases of targeted after the investigation. Adherence to the QIs improved from 82% to 99% in LTBI bundle. We also assessed 170 patients with a negative or indeterminant IGRA results in the initial LTBI screening and evaluated by follow-up IGRA test after starting biologic agents, which showed 7% of IGRA positive conversion. Active tuberculosis was not reported in our study.
Conclusion: Implementation of monitoring of quality indicators based on guidelines leads the safety for the use of biologic agents in the treatment of rheumatic disease. Our results also indicate that although the evidence for the repeated IGRA and the positive conversion after starting biologic agents in patients with rheumatic diseases is lacking, follow-up IGRA test may be useful to prevent the activation of LTBI in areas that have a high incidence of active TB such as Japan.
To cite this abstract in AMA style:
Suyama Y, Kishimoto M, Min C, Kataoka Y, Suda M, Rokutanda R, Matsui Y, Yamaguchi KI, Tsuda T, Kaneshita S, Shimizu H, Okada M. A Quality Indicator for the Screening of Latent Tuberculosis Infection and the Result of Follow-up Interferon-Gamma-Release Assays in Patients with Rheumatic Disease Receiving Biologic Agents in a Japanese Hospital [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/a-quality-indicator-for-the-screening-of-latent-tuberculosis-infection-and-the-result-of-follow-up-interferon-gamma-release-assays-in-patients-with-rheumatic-disease-receiving-biologic-agents-in-a-jap/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-quality-indicator-for-the-screening-of-latent-tuberculosis-infection-and-the-result-of-follow-up-interferon-gamma-release-assays-in-patients-with-rheumatic-disease-receiving-biologic-agents-in-a-jap/