Overuse of Tuberculosis Surveillance Testing in Patients With Inflammatory Bowel Disease Compared to Non-IBD Patients on Biologic Therapy
Abstract Background Biologic treatment for moderate to severe inflammatory bowel disease (IBD) places patients at risk for infectious complications. Tuberculosis (TB) infection and reactivation can lead to serious morbidity and mortality for immunosuppressed patients. As a result, guidelines recomme...
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| Veröffentlicht in: | Crohn's & Colitis 360 2021-07, Vol.3 (3), p.otab026 |
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| creator | Fine, Sean Vecchio, Marc Filipe Goncalves Monteiro, Joao Vecchio, Eric Mao, Eric J |
| description | Abstract
Background
Biologic treatment for moderate to severe inflammatory bowel disease (IBD) places patients at risk for infectious complications. Tuberculosis (TB) infection and reactivation can lead to serious morbidity and mortality for immunosuppressed patients. As a result, guidelines recommend screening for TB before starting biologic treatment, but a paucity of data remains on the utility of surveillance testing.
Methods
We performed a retrospective chart review at a single academic center evaluating both IBD and non-IBD patients on biologic therapy. The primary outcome was to determine the number of subsequent surveillance tests performed after initial screening for latent TB in both patient groups.
Results
A total of 188 patients (147 IBD and 41 non-IBD patients) on biologic therapy were included. Screening for TB before biologic treatment was performed in 56% of non-IBD patients versus 83% for patients with IBD (P = 0.0003). Of the total cohort, 65% had at least 2 follow-up surveillance tests for TB. Three or more surveillance tests were performed in 40% of patients with IBD versus only 13% for non-IBD patients (P = 0.0132). A total of 7 patients (4%) had an abnormal surveillance test. No patients were confirmed to have a diagnosis of TB or underwent treatment.
Conclusions
Patients on biologic therapy unnecessarily undergo surveillance testing for TB. Patients with IBD on biologic therapy are screened annually for TB at a higher rate compared to non-IBD patients. Standardization of care among patients on biologic therapy is necessary to avoid excessive testing in areas with a low incidence of TB.
Lay Summary
IBD patients on biologic therapy had higher frequencies of repeat surveillance testing for tuberculosis than non-IBD patients. The overall rate of abnormal tuberculosis surveillance tests was low in the cohort and there were no documented cases of infection or reactivation. |
| doi_str_mv | 10.1093/crocol/otab026 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2775951022</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A772853128</galeid><oup_id>10.1093/crocol/otab026</oup_id><sourcerecordid>A772853128</sourcerecordid><originalsourceid>FETCH-LOGICAL-c436t-fd93b3174b3fc3c29d94f8601e77fef91b039df2a70b6df93b37e80c6980cde33</originalsourceid><addsrcrecordid>eNqFkU9rFDEYh4MottRePUqOepg2f2aSmWN3a-tCsQVX9DZkMm-2kcxkTDKV_Qj91s2yq_VWAkkIz-9HXh6E3lNyRknDz3Xw2rtzn1RHmHiFjpngtKiZ_Pn6v_sROo3xFyGEVWVVEvIWHXEhpRAVO0aPtw8Q5gjYG7yeOwh6dj7aiL_N4QGsc2rUgNcQkx032I74TiULY4r4h033eDUap4ZBJR-2eOH_gMOXNoLKhUs_TCpAj5PHX_1YrBaXz2E_4oX1zm-sxut7CGravkNvjHIRTg_nCfp-9Xm9_FLc3F6vlhc3hS65SIXpG95xKsuOG801a_qmNLUgFKQ0YBraEd70hilJOtGbHSyhJlo0eeuB8xP0cd87Bf97zoO1g40adpOCn2PLpKyaihLGMnq2RzfKQWtH41NQOq8eBqv9CMbm9wspWV1xyurnQDYTYwDTTsEOKmxbStqdsnavrD0oy4EPh8_M3QD9P_yvoAx82gN-nl4qewJvIaSL</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2775951022</pqid></control><display><type>article</type><title>Overuse of Tuberculosis Surveillance Testing in Patients With Inflammatory Bowel Disease Compared to Non-IBD Patients on Biologic Therapy</title><source>DOAJ Directory of Open Access Journals</source><source>Access via Oxford University Press (Open Access Collection)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Fine, Sean ; Vecchio, Marc ; Filipe Goncalves Monteiro, Joao ; Vecchio, Eric ; Mao, Eric J</creator><creatorcontrib>Fine, Sean ; Vecchio, Marc ; Filipe Goncalves Monteiro, Joao ; Vecchio, Eric ; Mao, Eric J</creatorcontrib><description>Abstract
Background
Biologic treatment for moderate to severe inflammatory bowel disease (IBD) places patients at risk for infectious complications. Tuberculosis (TB) infection and reactivation can lead to serious morbidity and mortality for immunosuppressed patients. As a result, guidelines recommend screening for TB before starting biologic treatment, but a paucity of data remains on the utility of surveillance testing.
Methods
We performed a retrospective chart review at a single academic center evaluating both IBD and non-IBD patients on biologic therapy. The primary outcome was to determine the number of subsequent surveillance tests performed after initial screening for latent TB in both patient groups.
Results
A total of 188 patients (147 IBD and 41 non-IBD patients) on biologic therapy were included. Screening for TB before biologic treatment was performed in 56% of non-IBD patients versus 83% for patients with IBD (P = 0.0003). Of the total cohort, 65% had at least 2 follow-up surveillance tests for TB. Three or more surveillance tests were performed in 40% of patients with IBD versus only 13% for non-IBD patients (P = 0.0132). A total of 7 patients (4%) had an abnormal surveillance test. No patients were confirmed to have a diagnosis of TB or underwent treatment.
Conclusions
Patients on biologic therapy unnecessarily undergo surveillance testing for TB. Patients with IBD on biologic therapy are screened annually for TB at a higher rate compared to non-IBD patients. Standardization of care among patients on biologic therapy is necessary to avoid excessive testing in areas with a low incidence of TB.
Lay Summary
IBD patients on biologic therapy had higher frequencies of repeat surveillance testing for tuberculosis than non-IBD patients. The overall rate of abnormal tuberculosis surveillance tests was low in the cohort and there were no documented cases of infection or reactivation.</description><identifier>ISSN: 2631-827X</identifier><identifier>EISSN: 2631-827X</identifier><identifier>DOI: 10.1093/crocol/otab026</identifier><identifier>PMID: 36776652</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adalimumab ; Care and treatment ; Complications and side effects ; Disease susceptibility ; Medical screening ; Medical tests ; Tuberculosis</subject><ispartof>Crohn's & Colitis 360, 2021-07, Vol.3 (3), p.otab026</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of Crohn's & Colitis Foundation. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of Crohn's & Colitis Foundation.</rights><rights>COPYRIGHT 2021 Oxford University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-fd93b3174b3fc3c29d94f8601e77fef91b039df2a70b6df93b37e80c6980cde33</citedby><cites>FETCH-LOGICAL-c436t-fd93b3174b3fc3c29d94f8601e77fef91b039df2a70b6df93b37e80c6980cde33</cites><orcidid>0000-0002-3993-5773</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,864,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36776652$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fine, Sean</creatorcontrib><creatorcontrib>Vecchio, Marc</creatorcontrib><creatorcontrib>Filipe Goncalves Monteiro, Joao</creatorcontrib><creatorcontrib>Vecchio, Eric</creatorcontrib><creatorcontrib>Mao, Eric J</creatorcontrib><title>Overuse of Tuberculosis Surveillance Testing in Patients With Inflammatory Bowel Disease Compared to Non-IBD Patients on Biologic Therapy</title><title>Crohn's & Colitis 360</title><addtitle>Crohns Colitis 360</addtitle><description>Abstract
Background
Biologic treatment for moderate to severe inflammatory bowel disease (IBD) places patients at risk for infectious complications. Tuberculosis (TB) infection and reactivation can lead to serious morbidity and mortality for immunosuppressed patients. As a result, guidelines recommend screening for TB before starting biologic treatment, but a paucity of data remains on the utility of surveillance testing.
Methods
We performed a retrospective chart review at a single academic center evaluating both IBD and non-IBD patients on biologic therapy. The primary outcome was to determine the number of subsequent surveillance tests performed after initial screening for latent TB in both patient groups.
Results
A total of 188 patients (147 IBD and 41 non-IBD patients) on biologic therapy were included. Screening for TB before biologic treatment was performed in 56% of non-IBD patients versus 83% for patients with IBD (P = 0.0003). Of the total cohort, 65% had at least 2 follow-up surveillance tests for TB. Three or more surveillance tests were performed in 40% of patients with IBD versus only 13% for non-IBD patients (P = 0.0132). A total of 7 patients (4%) had an abnormal surveillance test. No patients were confirmed to have a diagnosis of TB or underwent treatment.
Conclusions
Patients on biologic therapy unnecessarily undergo surveillance testing for TB. Patients with IBD on biologic therapy are screened annually for TB at a higher rate compared to non-IBD patients. Standardization of care among patients on biologic therapy is necessary to avoid excessive testing in areas with a low incidence of TB.
Lay Summary
IBD patients on biologic therapy had higher frequencies of repeat surveillance testing for tuberculosis than non-IBD patients. The overall rate of abnormal tuberculosis surveillance tests was low in the cohort and there were no documented cases of infection or reactivation.</description><subject>Adalimumab</subject><subject>Care and treatment</subject><subject>Complications and side effects</subject><subject>Disease susceptibility</subject><subject>Medical screening</subject><subject>Medical tests</subject><subject>Tuberculosis</subject><issn>2631-827X</issn><issn>2631-827X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNqFkU9rFDEYh4MottRePUqOepg2f2aSmWN3a-tCsQVX9DZkMm-2kcxkTDKV_Qj91s2yq_VWAkkIz-9HXh6E3lNyRknDz3Xw2rtzn1RHmHiFjpngtKiZ_Pn6v_sROo3xFyGEVWVVEvIWHXEhpRAVO0aPtw8Q5gjYG7yeOwh6dj7aiL_N4QGsc2rUgNcQkx032I74TiULY4r4h033eDUap4ZBJR-2eOH_gMOXNoLKhUs_TCpAj5PHX_1YrBaXz2E_4oX1zm-sxut7CGravkNvjHIRTg_nCfp-9Xm9_FLc3F6vlhc3hS65SIXpG95xKsuOG801a_qmNLUgFKQ0YBraEd70hilJOtGbHSyhJlo0eeuB8xP0cd87Bf97zoO1g40adpOCn2PLpKyaihLGMnq2RzfKQWtH41NQOq8eBqv9CMbm9wspWV1xyurnQDYTYwDTTsEOKmxbStqdsnavrD0oy4EPh8_M3QD9P_yvoAx82gN-nl4qewJvIaSL</recordid><startdate>202107</startdate><enddate>202107</enddate><creator>Fine, Sean</creator><creator>Vecchio, Marc</creator><creator>Filipe Goncalves Monteiro, Joao</creator><creator>Vecchio, Eric</creator><creator>Mao, Eric J</creator><general>Oxford University Press</general><scope>TOX</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IAO</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3993-5773</orcidid></search><sort><creationdate>202107</creationdate><title>Overuse of Tuberculosis Surveillance Testing in Patients With Inflammatory Bowel Disease Compared to Non-IBD Patients on Biologic Therapy</title><author>Fine, Sean ; Vecchio, Marc ; Filipe Goncalves Monteiro, Joao ; Vecchio, Eric ; Mao, Eric J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c436t-fd93b3174b3fc3c29d94f8601e77fef91b039df2a70b6df93b37e80c6980cde33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adalimumab</topic><topic>Care and treatment</topic><topic>Complications and side effects</topic><topic>Disease susceptibility</topic><topic>Medical screening</topic><topic>Medical tests</topic><topic>Tuberculosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fine, Sean</creatorcontrib><creatorcontrib>Vecchio, Marc</creatorcontrib><creatorcontrib>Filipe Goncalves Monteiro, Joao</creatorcontrib><creatorcontrib>Vecchio, Eric</creatorcontrib><creatorcontrib>Mao, Eric J</creatorcontrib><collection>Access via Oxford University Press (Open Access Collection)</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale Academic OneFile</collection><collection>MEDLINE - Academic</collection><jtitle>Crohn's & Colitis 360</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fine, Sean</au><au>Vecchio, Marc</au><au>Filipe Goncalves Monteiro, Joao</au><au>Vecchio, Eric</au><au>Mao, Eric J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Overuse of Tuberculosis Surveillance Testing in Patients With Inflammatory Bowel Disease Compared to Non-IBD Patients on Biologic Therapy</atitle><jtitle>Crohn's & Colitis 360</jtitle><addtitle>Crohns Colitis 360</addtitle><date>2021-07</date><risdate>2021</risdate><volume>3</volume><issue>3</issue><spage>otab026</spage><pages>otab026-</pages><issn>2631-827X</issn><eissn>2631-827X</eissn><abstract>Abstract
Background
Biologic treatment for moderate to severe inflammatory bowel disease (IBD) places patients at risk for infectious complications. Tuberculosis (TB) infection and reactivation can lead to serious morbidity and mortality for immunosuppressed patients. As a result, guidelines recommend screening for TB before starting biologic treatment, but a paucity of data remains on the utility of surveillance testing.
Methods
We performed a retrospective chart review at a single academic center evaluating both IBD and non-IBD patients on biologic therapy. The primary outcome was to determine the number of subsequent surveillance tests performed after initial screening for latent TB in both patient groups.
Results
A total of 188 patients (147 IBD and 41 non-IBD patients) on biologic therapy were included. Screening for TB before biologic treatment was performed in 56% of non-IBD patients versus 83% for patients with IBD (P = 0.0003). Of the total cohort, 65% had at least 2 follow-up surveillance tests for TB. Three or more surveillance tests were performed in 40% of patients with IBD versus only 13% for non-IBD patients (P = 0.0132). A total of 7 patients (4%) had an abnormal surveillance test. No patients were confirmed to have a diagnosis of TB or underwent treatment.
Conclusions
Patients on biologic therapy unnecessarily undergo surveillance testing for TB. Patients with IBD on biologic therapy are screened annually for TB at a higher rate compared to non-IBD patients. Standardization of care among patients on biologic therapy is necessary to avoid excessive testing in areas with a low incidence of TB.
Lay Summary
IBD patients on biologic therapy had higher frequencies of repeat surveillance testing for tuberculosis than non-IBD patients. The overall rate of abnormal tuberculosis surveillance tests was low in the cohort and there were no documented cases of infection or reactivation.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>36776652</pmid><doi>10.1093/crocol/otab026</doi><orcidid>https://orcid.org/0000-0002-3993-5773</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Crohn's & Colitis 360, 2021-07, Vol.3 (3), p.otab026 |
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| source | DOAJ Directory of Open Access Journals; Access via Oxford University Press (Open Access Collection); EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Adalimumab Care and treatment Complications and side effects Disease susceptibility Medical screening Medical tests Tuberculosis |
| title | Overuse of Tuberculosis Surveillance Testing in Patients With Inflammatory Bowel Disease Compared to Non-IBD Patients on Biologic Therapy |
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