Screening for Mycobacterium tuberculosis prior to anti-TNF therapy--an audit of impact of the British Thoracic Society guidelines on rheumatology practice in an area of low Mycobacterium tuberculosis prevalence

Pradeep, John; Clunie, Gavin; Gaffney, Karl; Innes, Nicholas J.; Brooksby, A; Bradley, Pamela; Gulati, Atul

doi:10.1093/rheumatology/ken425

Cited by 6 publications

(2 citation statements)

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“…ECCO guidelines recommend that if latent TB is present, anti-TNF should be delayed for at least 3 weeks after starting chemoprophylaxis and infectious diseases specialist advice sought [Rahier et al 2009]. One group from East Anglia have audited the impact of TB screening in areas of low TB incidence in 339 patients with rheumatoid arthritis taking anti-TNFs [Pradeep et al 2009]. A tuberculin test was done in 81 patients (24%), 238 (92%) had a CXR and 15 (4.4%) needed specialist referrals.…”

Section: Tuberculosismentioning

confidence: 99%

Prevention of infection caused by immunosuppressive drugs in gastroenterology

Orlicka

Barnes

Culver

2013

Therapeutic Advances in Chronic Disease

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Immunosuppressive therapy is frequently used to treat gastrointestinal diseases such as inflammatory bowel disease, autoimmune hepatitis, IgG4-related disease (autoimmune pancreatitis and sclerosing cholangitis) and in the post-transplantation setting. These drugs interfere with the immune system. The main safety concern with their use is the risk of infections. Certain infections can be prevented or their impact minimized. Physicians must adopt preventative strategies and should have a high degree of suspicion to recognize infections early and treat appropriately. This article reviews the risk factors for infections, the mechanism of action of immunosuppressive therapy and proposes preventive strategies.

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Section: Tuberculosismentioning

confidence: 99%

Prevention of infection caused by immunosuppressive drugs in gastroenterology

Orlicka

Barnes

Culver

2013

Therapeutic Advances in Chronic Disease

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“…To our knowledge, this is the first reported audit of broad clinical management of LTBI, although smaller audits have reviewed specific aspects such as screening pre-TNF α inhibitor use [ 9 ]. Participants included both respiratory and infectious diseases clinicians, were recruited across all Australian states and territories and New Zealand, and provided actual practice information about current clinical management of LTBI in Australia and New Zealand.…”

Section: Discussionmentioning

confidence: 99%

Management of Latent Tuberculosis Infections in Australia and New Zealand: A Review of Current Practice

Denholm

McBryde

2010

Tuberculosis Research and Treatment

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Aim: To survey practices in the diagnosis and management of latent tuberculosis infection (LTBI) in Australia and New Zealand. Methods: Infectious diseases and respiratory physicians and trainees were invited to complete an online questionnaire concerning various aspects of LTBI management. Results: The questionnaire was completed by 126 clinicians self-reporting regular management of LTBI. Respondents were experienced physicians, with 95/126 (75.4%) having managed LTBI for more than 5 years. Forty-seven (37.3%) reported seeing more than 5 patients per month for assessment of LTBI. Substantial variation among clinicians was reported in relation to a number of common clinical scenarios. For instance, while 52/126 (43.7%) informed patients that the incidence of severe hepatotoxicity related to isoniazid monotherapy was 0.1–0.5%, 21/126 (15.7%) thought it was >5%. 36/126 (28.6%) clinicians would proceed with TNF-αtherapy following an indeterminate screening: interferon-γassay, while 78/126 (61.9%) would perform further investigations and 12/126 (9.5%) would initiate isoniazid therapy. Follow-up intervals during therapy varied from 1–3 monthly, with liver function testing performed routinely by 89/126 (70.6%). Conclusion: This study demonstrated a large degree of variation in clinical practice of LTBI management in Australia and New Zealand. Strategies for increasing uniformity of practice are required, including improved guidelines and physician education.

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