The Prevalence of Latent Tuberculosis and Hepatitis B Found after Systematic Screening of Patients Starting with Biological Therapy in a Low-Endemic Area

Marin de Jong^1,2, Danielle Roosen¹, Andy Peters¹, Valerie Verstraeten³, Marieke Pierik¹ and A. van Tubergen⁴, ¹Department of Internal Medicine, division of Gastroenterology, Maastricht University Medical Centre, Maastricht, Netherlands, ²NUTRIM – School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands, ³Department of Dermatology, Maastricht University Medical Centre, Maastricht, Netherlands, ⁴Department of Internal Medicine, Rheumatology, Maastricht University Medical Center, Maastricht, Netherlands

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: anti-TNF therapy, Biologics, Hepatitis, prevention and tuberculosis

Session Information

Date: Sunday, November 13, 2016

Title: Quality Measures and Quality of Care - Poster I

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Biologicals are a powerful treatment option for moderate to severe immune-mediated inflammatory diseases (IMID). Since biologicals modulate the immune system, the risk for reactivation of latent infections with a fulminant disease course, such as tuberculosis (TBC) or Hepatitis B (HBV), is increased. Guidelines therefore recommend screening for TBC and HBV before starting biological therapy. In 2012, at the Maastricht University Medical Centre+, we have introduced a central, multi-disciplinary and systematic screening of all IMID patients starting biological therapy. Prevalence data from systematic screening for latent TBC infection (LTBI) and HBV in patients prescribed biological therapy in a low-endemic area have not been reported thus far.

Methods: All IMID patients commencing biological treatment from May 2012 through July 2015, were included. Screening consisted of a detailed medical history on risk factors for LTBI (e.g. previous diagnosis of TBC, close contact with a TBC-infected person, previous living outside Europe, North-America and/or Australia) and HBV infection (occupation, history of intravenous drug abuse, sexual behaviour), a Quantiferon test (QFT), serology for HBV (HBs-Ag, anti HB-core) and a chest X-ray.

Results: In total, 547 of 549 patients (99.6%) starting biological therapy were screened. One patient (0.2%) tested positive for HBV without having reported any risk factor. Table 1 shows that 22 patients (4.0%) tested positive on QFT and were classified as LTBI patients. Of these, 14 did not report any risk factor, 18 had always lived in The Netherlands and 18 had never travelled outside of Europe, North America or Australia. Four patients had abnormalities on chest X-ray, 3 of them also tested positive on QFT and the other one turned out to have sarcoidosis, not LTBI. All LTBI patients were treated with isoniazid therapy. After a mean follow-up period of 19.8 ±8.8 months none of the patients had a reactivation of LTBI after the start of biological therapy.

QFT Positive

N=22

QFT negative

N=525

Medical history, N (%) Risk factors No risk factors

8 (36.4)

14 (63.6)

37 (7.0)

488 (93.0)

Chest X-ray, N (%) Positive Negative

3 (13.6)

19 (86.4)

1 (0.2)

524 (99.8)

Table 1

Conclusion: The overall prevalence of LTBI and HBV in patients prescribed biological therapy in a low-endemic area is 4.0% and 0.2%, respectively. Systematic screening by means of QFT and HBV serology seems more reliable than history taking and chest X-rays alone. Since implementation of systematic screening of IMID patients, none of our patients showed reactivation of LTBI or HBV during biological therapy.

Disclosure: M. de Jong, None; D. Roosen, None; A. Peters, None; V. Verstraeten, None; M. Pierik, None; A. van Tubergen, None.

To cite this abstract in AMA style:

de Jong M, Roosen D, Peters A, Verstraeten V, Pierik M, van Tubergen A. The Prevalence of Latent Tuberculosis and Hepatitis B Found after Systematic Screening of Patients Starting with Biological Therapy in a Low-Endemic Area [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/the-prevalence-of-latent-tuberculosis-and-hepatitis-b-found-after-systematic-screening-of-patients-starting-with-biological-therapy-in-a-low-endemic-area/. Accessed .

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