TY - JOUR
T1 - Screening prior to biological therapy in Crohn's disease
T2 - Adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study
AU - Van der Have, Mike
AU - Belderbos, Tim D G
AU - Fidder, Herma H.
AU - Leenders, Max
AU - Dijkstra, Gerard
AU - Peters, Charlotte P.
AU - Eshuis, Emma J.
AU - Ponsioen, Cyriel Y.
AU - Siersema, Peter D.
AU - van Oijen, Martijn G H
AU - Oldenburg, Bas
PY - 2014
Y1 - 2014
N2 - Background: Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended. Aims: To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield. Methods: A multicentre retrospective study was conducted in Crohn's disease patients in whom infliximab or adalimumab was started between 2000 and 2010. Screening included tuberculin skin test, interferon-gamma release assay or chest X-ray for tuberculosis. Extended screening included screening for tuberculosis and viral infections. Patients were followed until three months after ending treatment. Primary endpoints were opportunistic and serious infections. Results: 611 patients were included, 91% on infliximab. 463 (76%) patients were screened for tuberculosis, of whom 113 (24%) underwent extended screening. Screening for tuberculosis and hepatitis B increased to, respectively, 90-97% and 36-49% in the last two years. During a median follow-up of two years, 64/611 (9%, 3.4/100 patient-years) opportunistic infections and 26/611 (4%, 1.6/100 patient-years) serious infections were detected. Comorbidity was significantly associated with serious infections (hazard ratio 3.94). Conclusions: Although screening rates for tuberculosis and hepatitis B increased, screening for hepatitis B was still suboptimal. More caution is required when prescribing biologicals in patients with comorbid conditions.
AB - Background: Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended. Aims: To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield. Methods: A multicentre retrospective study was conducted in Crohn's disease patients in whom infliximab or adalimumab was started between 2000 and 2010. Screening included tuberculin skin test, interferon-gamma release assay or chest X-ray for tuberculosis. Extended screening included screening for tuberculosis and viral infections. Patients were followed until three months after ending treatment. Primary endpoints were opportunistic and serious infections. Results: 611 patients were included, 91% on infliximab. 463 (76%) patients were screened for tuberculosis, of whom 113 (24%) underwent extended screening. Screening for tuberculosis and hepatitis B increased to, respectively, 90-97% and 36-49% in the last two years. During a median follow-up of two years, 64/611 (9%, 3.4/100 patient-years) opportunistic infections and 26/611 (4%, 1.6/100 patient-years) serious infections were detected. Comorbidity was significantly associated with serious infections (hazard ratio 3.94). Conclusions: Although screening rates for tuberculosis and hepatitis B increased, screening for hepatitis B was still suboptimal. More caution is required when prescribing biologicals in patients with comorbid conditions.
KW - Anti-TNF therapy
KW - Inflammatory bowel disease
KW - Opportunistic infections
KW - Prevention
UR - http://www.scopus.com/inward/record.url?scp=84904778545&partnerID=8YFLogxK
U2 - 10.1016/j.dld.2014.07.006
DO - 10.1016/j.dld.2014.07.006
M3 - Article
SN - 1590-8658
VL - 46
SP - 881
EP - 886
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
ER -