Biological therapy in arthritis patients with hepatitis B or C infection: a multicenter retrospective case series

Abdulaziz, Sultana; Halabi, Hussein; Omair, Mohammed A.; Attar, Suzan M.; Alghamdi, Abdullah S; Shabrawishi, Mohammed; Neyazi, Abdulwahab; Alnazzawi, Haneen; Meraiani, Nuha; Almoallim, Hani

doi:10.5152/eurjrheum.2017.17003

Cited by 10 publications

(1 citation statement)

References 29 publications

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“…While these drugs have improved disease management, there is an increased risk of latent infectious disease reactivation with certain agents (1,2). The depletion of or interference with certain cytokines could lead to reactivation of hepatitis B (HBV) (3)(4)(5)(6), hepatitis C (HCV) (6), and tuberculosis (TB) (7). Patients receiving certain immunomodulators may also have increased susceptibility to influenza and pneumococcal infections.…”

Section: Introductionmentioning

confidence: 99%

Ambulatory Medication Safety: Vaccination and Laboratory Screening for Patients Receiving Immunomodulatory Therapies

McDonnell

Iversen

Khinkar

et al. 2022

Arthritis Care & Research

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Objective. Immunomodulatory therapies improve the management of chronic diseases but can be associated with infectious risk. The present study was undertaken to examine the laboratory screening practices for hepatitis B virus (HBV), hepatitis C virus (HCV), and tuberculosis (TB) and rates of vaccination for pneumococcal and influenza in patients prescribed select immunosuppressive agents at our institution.Methods. A retrospective analysis was conducted to review patients who were prescribed a select immunosuppressive over 3 years. Data were extracted from electronic health records to identify rates of screening and vaccination prior to initiation or at any time. Logistic regression models were developed to identify predictors of screening and vaccination.Results. We identified 2,396 patients prescribed immunosuppressive medications by rheumatology (52.6%) and non-rheumatology specialties. Rates of screening at any time point were 84.5% (2,025 of 2,396) for HBV, 76.7% (1,838 of 2,396) for HCV, and 71.8% (1,720 of 2,396) for TB. Patients who had either in-system primary care providers (PCPs) or rheumatologists were more likely to receive pneumococcal vaccinations (odds ratio [OR] 1.98 [95% confidence interval (95% CI) 1.55-2.54] and OR 4.08 [95% CI 2.76-6.02], respectively). Patients with dermatologic (OR 1.67 [95% CI 1.14-2.45]) or rheumatologic providers (OR 2.5 [95% CI 1.86-3.36]) were more likely to be vaccinated for influenza.Conclusion. More than 70% of patients were screened for either HBV, HCV, or TB at some point. Rates of pneumococcal vaccination were better than rates of influenza vaccination. Patients with in-system PCPs were more likely to be screened and vaccinated. Establishing and executing consistent processes for screening and vaccination prior to immunosuppressive treatment remains a priority in ambulatory settings.

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