Screening prior to biological therapy in Crohn's disease: Adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

Mike Van der Have*, Tim D G Belderbos, Herma H. Fidder, Max Leenders, Gerard Dijkstra, Charlotte P. Peters, Emma J. Eshuis, Cyriel Y. Ponsioen, Peter D. Siersema, Martijn G H van Oijen, Bas Oldenburg

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)881-886
    Number of pages6
    JournalDigestive and Liver Disease
    Volume46
    DOIs
    Publication statusPublished - 2014

    Keywords

    • Anti-TNF therapy
    • Inflammatory bowel disease
    • Opportunistic infections
    • Prevention

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