P774 Low adhesion to latent tuberculosis (TB) screening recommendations in inflammatory bowel disease (IBD) patients: Results of the INFEII registry of GETECCU

Y. Zabana Abdo1,2, R. de Francisco3, I. Rodríguez-Lago4, M. Chaparro2,5,6, F. Gomollón2,7,8, M. Piqueras9, J. Llaó10, B. Sicilia11, E. Domènech2,12, O. García-Bosch13, L. de Castro14, X. Calvet2,15,16, V. Morales17, M. Rivero18, A.J. Lucendo2,6,19, P. Navarro20, L. Márquez21,22, D. Busquets23, J. Guardiola24,25, J. Gordillo26, E. Iglesias27, B. Beltrán2,28, E. Sesé29, R. Ferreiro-Iglesias30, M. Francisco31, R. Pajares32, A. Algaba33,34, R. Vicente35, O. Benítez1, M. Aceituno1,2, S. Riestra3, A. Rodríguez-Pescador4, J.P. Gisbert2,5,6, M.T. Arroyo7,8, R. Mena9, E. Sáinz10, L. Arias-García11, M. Mañosa2,12, M. Navarro13, L. Sanromán14, A. Villória2,15,16, P. Delgado-Villena17, M.J. García18, T. Angueira19, M. Mínguez20, F. Murciano21,22, C. Arajol24, M. Esteve1,2, Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU)

1Hospital Universitari Mutua De Terrassa, Gastroenterology Department, Terrassa, Spain, 2Instituto Carlos III-CIBEREHD, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBEREHD, Madrid, Spain, 3Hospital Central de Asturias, Gastroenterology Department, Oviedo, Spain, 4Hospital de Galdakao, Gastroenterology Department, Bilbao, Spain, 5Hospital Universitario de La Princesa, Gastroenterology, Madrid, Spain, 6Instituto de Investigación Sanitaria Princesa IIS-IP, Instituto de Investigación Sanitaria Princesa IIS-IP, Madrid, Spain, 7Hospital Clínico Lozano Blesa, Gastroenterology Department, Zaragoza, Spain, 8Instituto de Investigación Sanitaria de Aragón IIS, Instituto de Investigación Sanitaria de Aragón IIS, Zaragoza, Spain, 9Consorci Sanitari de Terrassa, Gastroenterology Department, Terrassa, Spain, 10Hospital Sant Joan de Déu Althaia, Gastroenterology Department, Manresa, Spain, 11Hospital Universitario de Burgos, Gastroenterology Department, Burgos, Spain, 12Hospital Universitari Germans Trias i Pujol, Gastroenterology Department, Badalona, Spain, 13Hospital Moisés Broggi, Gastroenterology Department, Sant Joan Despí, Spain, 14Hospital Álvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, Gastroenterology Department, Vigo, Spain, 15Hospital Universitari Parc Taulí Sabadell, Gastroenterology Department, Sabadell, Spain, 16Facultat de Medicina- Universitat Autònoma de Barcelona, Medicine Department, Barcelona, Spain, 17Hospital General de Granollers, Gastroenterology Department, Granollers, Spain, 18Hospital Marqués de Valdecilla- IDIVAL, Gastroenterology Department, Santander, Spain, 19Hospital General de Tomelloso, Gastroenterology Department, Tomelloso, Spain, 20Hospital Clínico de Valencia, Gastroenterology Department, Valencia, Spain, 21Hospital del Mar, Servei de Digestiu, Barcelona, Spain, 22Hospital del Mar Research Institute IMIM, Hospital del Mar Research Institute IMIM, Barcelona, Spain, 23Hospital Universitari Dr. Josep Trueta, Gastroenterology Department, Girona, Spain, 24Hospital Universitari Bellvitge- IDIBELL, Gastroenterology Department, L’Hospitalet de Llobregat, Spain, 25Universitat de Barcelona, Medicine Department, Barcelona, Spain, 26Hospital Santa Creu i Sant Pau, Gastroenterology Department, Barcelona, Spain, 27Hospital Reina Sofía, Gastroenterology Department, Córdova, Spain, 28Hospital Universitario La Fe, Gastroenterology Department, Valencia, Spain, 29Hospital Arnau de Vilanova, Gastroenterology Deparment, Lleida, Spain, 30Hospital Universitario Santiago, Gastroenterology Department, Santiago de Compostela, Spain, 31Hospital Universitario Ramón y Cajal, Gastroenterology Department, Madrid, Spain, 32Hospital Infanta Sofía, Gastroenterology Department, San Sebastián de los Reyes, Spain, 33Hospital Universitario de Fuenlabrada, Gastroenterology Department, Fuenlabrada, Spain, 34Instituto de Investigación de La Paz IdiPAZ, Instituto de Investigación de La Paz IdiPAZ, Madrid, Spain, 35Hospital Universitario Miguel Servet, Gastroenterology Department, Zaragoza, Spain

Background

INFEII registry (ClinicalTrials.gov: NCT02904590) is a prospective study promoted by GETECCU to determine the incidence and risk factors of infection in an inception cohort of IBD patients. Despite preventive measures and recommendations of scientific societies, TB remains a problem in patients with IBD treated with immunosuppressants (IMM) and biologics.

Methods

AIMS:

To asses: (1) the screening of TB performed at the time of inclusion of a patient in the INFEII registry, (2) the incidence of latent TB; and (3) compliance with national and European recommendations.

Results

A longitudinal prospective study of incident cases with IBD, initiated in October 2016 and with a planned follow-up of 5 years. In September 2019, INFEII registry had 1241 patients from 28 centres throughout Spain. The study protocol determines the mandatory fulfilment of TB screening in every patient, leaving to the centre the freedom of decision on what procedures to perform. Guidelines recommend a mandatory study before starting immunosuppression, especially with biological treatment, using the combination of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) or at least one TST with a booster test1,2.

Conclusion

Of the 1241 patients 233 (19%) had no screening, 494 (40%) had one [TST 158, IGRA 299, thorax-X-ray 37], 288 (23%) two [TST + IGRA 87, IGRA + thorax-X-ray 130, TST + thorax-X-ray 30, TST + booster 41], 128 (10%) three [TST + IGRA + thorax-X-ray 65, TST + booster + IGRA 23, TST + booster + thorax-X-ray 40] and 98 (7.9%) the four tests [TST + booster + IGRA + thorax-X-ray]. 486 patients (48%) receive pharmacological immunosuppression (172 IMMS, 195 biologics, 119 COMBO) and from them 198 (41%) followed the guidelines recommendation (131 TST and IGRA and 118 TST-booster), 245 (50%) had some method for TB screening [TST 43, IGRA 112, thorax-X-ray 15, IGRA + thorax-X-ray 57, TST + thorax-X-ray 18] and 43 patients (8.8%) had no screening. With the baseline screening, latent TB was detected in 134 patients (13%), 63 (47%) receiving anti-TB chemotherapy. In patients initiating immunosuppression, latent TB was detected in 35 cases [of which 28 received prophylaxis but 7 under IMM did not]. Active TB was detected in 4 cases: 2 during baseline screening, one without screening and one with negative screening (negative TST and IGRA, without booster receiving biological treatment).

Despite TB in IBD is a relevant problem, there is ample room for improvement for the implementation of mandatory minimum screening recommendations, even in prospective protocolised projects.

References:

Riestra S, Enferm Inflamatoria Intest al Dia, 2015;14(3):109–19. 2.

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