RT Journal Article
SR Electronic
T1 Screening tests for latent tuberculosis prior to anti-TNF alpha therapy – a systematic review and meta-analysis
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA2975
DO 10.1183/13993003.congress-2019.PA2975
VO 54
IS suppl 63
A1 Andreia Filipa Fonseca Carriço
A1 André Ramalho
A1 João Santos
A1 Luís Azevedo
A1 Raquel Duarte
A1 Alberto Freitas
YR 2019
UL http://erj.ersjournals.com/content/54/suppl_63/PA2975.abstract
AB Objectives: To assess the proportion of positive screenings for latent tuberculosis infection (LTBI) before starting biological therapy and to analyse the effectiveness of screening and prophylaxis in preventing active tuberculosis (TB).Methods: Comprehensive and systematic literature search in four electronic databases (Pubmed, Cochrane, Scopus and ISI-WOS) from inception until October 2017 involving LTBI screening in patients who are candidates for anti-TNF alpha therapy with rheumatic, dermatological and gastroenterological diseases. We used an appropriate methodology based on the PRISMA Statement for systematic reviews.Results: Twenty-one studies were included. In pooled analyses, 12,836 patients had undergone TST and/or IGRA before TNF inhibitors use. Positive screening results ranged from 8% to 44%, depending on the incidence rate of TB in each country. In the analysis of positive screenings with prophylaxis versus no prophylaxis, all the studies observed greater protection, favouring prophylaxis treated patients. However, even during prophylactic treatment, there were few cases of active TB (0.52%). The occurrence of active TB in patients who did not perform prophylaxis was approximately 10% and even in those with negative initial screening the TB rate was 0.21%.Conclusion: This meta-analysis reaffirms the current evidence that the screening tests for tuberculosis prior to anti-TNF and prophylactic treatment of LTBI decrease the odds of developing active disease. There is still risk of developing active TB in patients with negative screening and even in patients with positive screening that received adequate prophylaxis.FootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA2975.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).