P652 The prevalence of latent tuberculosis and hepatitis B found after systematic screening of patients starting with biological therapy in a low-endemic area
M. de Jong*1, 2, D. Roosen1, A. Peters3, A. Masclee1, 2, V. Verstraeten4, A. van Tubergen5, 6, M. Pierik1, 2
1Maastricht University Medical Centre+, Department of Internal Medicine, division of Gastroenterology and Hepatology, Maastricht, Netherlands, 2Maastricht University Medical Centre+, NUTRIM – School for Nutrition and Translational Research in Metabolism, Maastricht, Netherlands, 3Maastricht University Medical Centre+, Department of Internal Medicine, Maastricht, Netherlands, 4Maastricht University Medical Centre+, Department of Dermatology, Maastricht, Netherlands, 5Maastricht University Medical Centre+, Department of Internal Medicine, division of Rheumatology, Maastricht, Netherlands, 6Maastricht University Medical Centre+, CAPHRI - School for Public Health and Primary Care, Maastricht, Netherlands
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. Since 2012, in Maastricht University Medical Centre+, we have had a central, multidisciplinary, 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.
From May 2012 through July 2015, all IMID patients commencing biological treatment were included. Screening consisted of a detailed medical history on risk factors for LTBI (previous diagnosis of TBC, close contact with a TBC-infected person, previous living outside Europe, North America, and Australia) and HBV infection (occupation, history of intravenous drug abuse, and sexual behaviour), a Quantiferon test (QFT), serology for HBV (HBs-Ag, anti-HB-core), and a chest X-ray.
In total, 547 of 549 patients (99.6%) starting biological therapy were screened. One patient (0.2%) tested positive for HBV and did not report any risk factor. As shown in Table 1, 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 another 18 never travelled outside of Europe, North America, or Australia. Further, 4 patients had abnormalities on chest X-ray; 3 of them also tested positive on QFT; and the other 1 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.
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, no patients showed reactivation of LTBI or HBV during biological therapy.