Expert views on screening for tuberculosis infection in patients commencing treatment with a biologic agent

Objective: Many biologic agents cause some degree of immunosuppression, which can increase the risk of reactivation of tuberculosis infection (TBI). This risk is variable between individual biologics. We aimed to assess current (and recommended) clinical practice of TBI screening and treatment among...

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Bibliographic Details
Published in:Jornal brasileiro de pneumologia Vol. 50; no. 4; p. e20240082
Main Authors: Sultana1,2, Adiba, Battista Migliori3, Giovanni, D’Ambrosio,4, Lia, García-García5, José-María, Rossato Silva6, Denise, Adrian Rendon5, Luis, R Codecasa7, Luigi, Blanc8, Francois-Xavier, Tiberi9, Simon, W M Ong10,11,12, Catherine, Heffernan13, Courtney, Sotgiu14, Giovanni, Centis3, Rosella, Caroline Dobler1,2, Claudia, Network, The Global Tuberculosis
Format: Journal Article
Language:English
Published: Brazil Sociedade Brasileira de Pneumologia e Tisiologia 2024
Subjects:
Biological products
Biological Products - adverse effects
Biological Products - therapeutic use
Humans
Immunosuppression therapy
Latent tuberculosis
Latent Tuberculosis - diagnosis
Latent Tuberculosis - drug therapy
Life Sciences
Mass screening
Mass Screening - methods
Original
Recurrence
RESPIRATORY SYSTEM
Risk Factors
Surveys and Questionnaires
Tuberculosis
Latent tuberculosis
Recurrence
Latent tuberculosis Biological products Immunosuppression therapy Recurrence Mass screening
Biological products
Immunosuppression therapy
Mass screening
ISSN:1806-3756, 1806-3713, 1806-3756
Online Access:Get full text
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Summary:Objective: Many biologic agents cause some degree of immunosuppression, which can increase the risk of reactivation of tuberculosis infection (TBI). This risk is variable between individual biologics. We aimed to assess current (and recommended) clinical practice of TBI screening and treatment among patients initiating treatment with biologic agents. Methods: An online questionnaire was distributed via email to members of the Global Tuberculosis Network and associated professional organisations to seek insights into the screening for and treatment of TBI in patients treated with biologics. Results: A total of 163 respondents in 27 countries answered at least one question. For all biologics described in the questionnaire, respondents advised increasing screening relative to current practice. Observed and supported TBI screening rates in patients treated with TNF-a inhibitors were high, especially for older TNF-a inhibitors. Most participants supported TBI screening in patients treated with B- or T-cell inhibitors but not in those treated with interleukin inhibitors. Guideline awareness was higher for TNF-a inhibitors than for other biologic classes (79% vs. 34%). Conclusions: Although respondents stated that TBI screening rates are lower than what they consider ideal, there was a tendency to recommend TBI screening in patients treated with biologics not known to be associated with an increased risk of TBI. As a result, there is a potential risk of over-screening and over-treatment of TBI, potentially causing harm, in patients treated with biologics other than TNF-a inhibitors. There is a need to research the risk of TBI associated with biologics and for guidelines to address the spectrum of TBI risk across all types of biologics.
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CONFLICTS OF INTEREST: None declared.
ISSN:1806-3756
1806-3713
1806-3756
DOI:10.36416/1806-3756/e20240082