Latent Tuberculosis Screening Among New Users of a Biologic or Targeted Synthetic Disease‐Modifying Antirheumatic Drug: Gaps in Screening Overall and Among Janus Kinase Inhibitors

Abstract

ObjectiveWe combined claims and EHR data to provide contemporary and accurate estimates of latent TB screening among new users of a biologic or targeted synthetic DMARD and assess potential gaps in testing by drug type, patient characteristics, and practice.MethodsOur denominator population was patients in the RISE registry and Medicare using a b/tsDMARD in 2018 without a claim or prescription in the year prior. TB screening was assessed in both Medicare and RISE 1 and 3 years before the medication start date. We calculated the proportion screened overall, by medication class, and by practice. We tested for demographic differences in screening using logistic regression.ResultsIn the year prior to drug starts, 65.6% of patients had any TB screening; in a 3‐year window, 72.9% had any TB screening. Rates of screening within 1 year by drug type were greater or equal to the overall screening rate for most drugs except for JAKi (46%) and IL‐17i (11.5%). A lower proportion of Hispanic and Asian patients were screened compared to White patients. Practice screening rates ranged from 20.0‐92.9% of patients within 1 year.ConclusionWe report higher screening rates than have previously been published due to combining claims and EHR data. However, important safety gaps remain, namely, reduced screening among new users of a JAKi or IL‐17i, among Asian and Hispanic patients, and low performing practices. Educational initiatives, team‐based care delivery, task shifting and technological interventions to address observed gaps in patient safety procedures are needed.