Latent tuberculosis infection detection and active tuberculosis prevention in patients receiving anti-TNF therapy: an Italian nationwide survey
Latent tuberculosis infection detection and active tuberculosis prevention in patients receiving anti-TNF therapy: an Italian nationwide survey
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DOI：
10.1111/1756-185x.12708
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发表时间：
2016-08-01
影响因子：
2.5
通讯作者：
Spadaro, Antonio
中科院分区：
文献类型：
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作者：
Cantini, Fabrizio;Lubrano, Ennio;Spadaro, Antonio
主要目的：调查意大利风湿病学在需要抗肿瘤坏死因子（抗 TNF）治疗的患者中潜伏性结核感染（LTBI）检测和结核病（TB）预防的实践。第二：评估 10 年来结核病病例总数及其按药物的分布。方法 393/449 (87.5%) 接受抗 TNF 治疗的风湿病专家完成了一份匿名的 24 份多重反应问卷。 6 个问题提供了设置信息，18 个问题提供了对建议的遵守情况和记录的结核病病例。结果 323 人 (82%) 使用了意大利建议，60 人 (15%) 使用了其他设置。总是有 81 名（21%）人向结核病专家咨询，偶尔有 73 名（19%）人向结核病专家咨询。 LTBI筛查采用胸片（CR）5%、微管素皮试（TST）5.3%、CR+TST 35.6%、干扰素-γ释放试验（IGRA）7.4%、CR+IGRAs 26%和CR+TST+IGRA 20.6%进行。 97 例（24.7%）在 TST 阳性的情况下开始使用异烟肼，101 例（25.7%）在 TST+IGRA 阳性的情况下开始使用异烟肼，195 例（49.6%）在 IGRA 阳性的情况下开始使用异烟肼。 63.1% 的病例延迟 1 个月开始抗 TNF 治疗，27.7% 的病例延迟 3 个月，同时延迟 5.6%。总体而言，39353名患者中出现了317例结核病再激活病例，发病率为80.5例/10万人/年（比意大利普通人群高10倍）。结核病预防期间发生结核病的人数为 192 人（60.6%）。结核病发病率按药物划分为：依那西普 (ETN) 51 (16%), 28/100000/年，阿达木单抗 (ADA) 98 (31%), 89/100000/年，英夫利昔单抗 (IFX) 137 (43.2%), 211/100000/年，与 ETN 组相比，发生率明显较低ADA 和 IFX 组 ((2)=P
AimsPrimary: to investigate Italian rheumatology practice regarding latent tubercular infection (LTBI) detection and tuberculosis (TB) prevention in patients requiring anti-tumor necrosis factor (anti-TNF) therapy. Secondary: to assess the overall number of TB cases over 10years and their distribution by drug.MethodsAn anonymous, 24 multiple-response questionnaire was completed by 393/449 (87.5%) rheumatologists prescribing anti-TNF therapy. Six questions provided setting information, and 18 the compliance with recommendations and the recorded TB cases.ResultsThe Italian recommendations were used by 323 (82%) and other sets by 60 (15%). TB specialists were always consulted by 81 (21%) and occasionally by 73 (19%). LTBI screening was made using chest radiograph (CR) by 5%, tuburculin skin test (TST) by 5.3%, CR+TST by 35.6%, interferon-gamma release assay (IGRA) by 7.4%, CR+IGRAs by 26% and CR+TST+IGRA by 20.6%. Isoniazid was initiated in the presence of positivity of TST by 97 (24.7%), TST+IGRA by 101 (25.7%) and IGRA by 195 (49.6%). Anti-TNF starting delay was 1month in 63.1% of the cases, 3months in 27.7%, concomitantly in 5.6%. Overall, 317 TB reactivation cases occurred in 39353 patients, with an incidence rate of 80.5 cases/100000/year (10 times higher than in the Italian general population). TB occurred during TB prophylaxis in 192 (60.6%). TB cases incidence rate divided by drug was: etanercept (ETN) 51 (16%), 28/100000/year, adalimumab (ADA) 98 (31%), 89/100000/year, infliximab (IFX) 137 (43.2%), 211/100000/year, with a significantly lower frequency in the ETN group compared to ADA and IFX groups ((2)=P