Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

Mike van der Have; Tim D G Belderbos; Herma H Fidder; Max Leenders; Gerard Dijkstra; Charlotte P Peters; Emma J Eshuis; Cyriel Y Ponsioen; Peter D Siersema; Martijn G H van Oijen; Bas Oldenburg

doi:10.1016/j.dld.2014.07.006

Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

Mike van der Have, Tim D G Belderbos, Herma H Fidder, Max Leenders, Gerard Dijkstra, Charlotte P Peters, Emma J Eshuis, Cyriel Y Ponsioen, Peter D Siersema, Martijn G H van Oijen, Bas Oldenburg,

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended.

AIMS: To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield.

METHODS: A multicentre retrospective study was conducted in Crohn's disease patients in whom infliximab or adalimumab was started between 2000 and 2010. Screening included tuberculin skin test, interferon-gamma release assay or chest X-ray for tuberculosis. Extended screening included screening for tuberculosis and viral infections. Patients were followed until three months after ending treatment. Primary endpoints were opportunistic and serious infections.

RESULTS: 611 patients were included, 91% on infliximab. 463 (76%) patients were screened for tuberculosis, of whom 113 (24%) underwent extended screening. Screening for tuberculosis and hepatitis B increased to, respectively, 90-97% and 36-49% in the last two years. During a median follow-up of two years, 64/611 (9%, 3.4/100 patient-years) opportunistic infections and 26/611 (4%, 1.6/100 patient-years) serious infections were detected. Comorbidity was significantly associated with serious infections (hazard ratio 3.94).

CONCLUSIONS: Although screening rates for tuberculosis and hepatitis B increased, screening for hepatitis B was still suboptimal. More caution is required when prescribing biologicals in patients with comorbid conditions.

Original language	English
Pages (from-to)	881-886
Number of pages	6
Journal	Digestive and liver disease
Volume	46
Issue number	10
DOIs	https://doi.org/10.1016/j.dld.2014.07.006
Publication status	Published - 2014

Keywords

Adalimumab
Adult
Anti-Inflammatory Agents
Antibodies, Monoclonal
Antibodies, Monoclonal, Humanized
Crohn Disease
Female
Follow-Up Studies
Guideline Adherence
Hepatitis B
Humans
Infliximab
Interferon-gamma Release Tests
Linear Models
Male
Netherlands
Opportunistic Infections
Practice Guidelines as Topic
Prevalence
Retrospective Studies
Tuberculin Test
Tuberculosis
Virus Diseases

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10.1016/j.dld.2014.07.006

Cite this

van der Have, M., Belderbos, T. D. G., Fidder, H. H., Leenders, M., Dijkstra, G., Peters, C. P., Eshuis, E. J., Ponsioen, C. Y., Siersema, P. D., van Oijen, M. G. H., Oldenburg, B. (2014). Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study. Digestive and liver disease, 46(10), 881-886. https://doi.org/10.1016/j.dld.2014.07.006

@article{991b2d74fc9a42e68aab7bac8085757e,

title = "Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study",

abstract = "BACKGROUND: Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended.AIMS: To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield.METHODS: A multicentre retrospective study was conducted in Crohn's disease patients in whom infliximab or adalimumab was started between 2000 and 2010. Screening included tuberculin skin test, interferon-gamma release assay or chest X-ray for tuberculosis. Extended screening included screening for tuberculosis and viral infections. Patients were followed until three months after ending treatment. Primary endpoints were opportunistic and serious infections.RESULTS: 611 patients were included, 91% on infliximab. 463 (76%) patients were screened for tuberculosis, of whom 113 (24%) underwent extended screening. Screening for tuberculosis and hepatitis B increased to, respectively, 90-97% and 36-49% in the last two years. During a median follow-up of two years, 64/611 (9%, 3.4/100 patient-years) opportunistic infections and 26/611 (4%, 1.6/100 patient-years) serious infections were detected. Comorbidity was significantly associated with serious infections (hazard ratio 3.94).CONCLUSIONS: Although screening rates for tuberculosis and hepatitis B increased, screening for hepatitis B was still suboptimal. More caution is required when prescribing biologicals in patients with comorbid conditions.",

keywords = "Adalimumab, Adult, Anti-Inflammatory Agents, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Crohn Disease, Female, Follow-Up Studies, Guideline Adherence, Hepatitis B, Humans, Infliximab, Interferon-gamma Release Tests, Linear Models, Male, Netherlands, Opportunistic Infections, Practice Guidelines as Topic, Prevalence, Retrospective Studies, Tuberculin Test, Tuberculosis, Virus Diseases",

author = "{van der Have}, Mike and Belderbos, {Tim D G} and Fidder, {Herma H} and Max Leenders and Gerard Dijkstra and Peters, {Charlotte P} and Eshuis, {Emma J} and Ponsioen, {Cyriel Y} and Siersema, {Peter D} and {van Oijen}, {Martijn G H} and Bas Oldenburg",

year = "2014",

doi = "10.1016/j.dld.2014.07.006",

language = "English",

volume = "46",

pages = "881--886",

journal = "Digestive and liver disease",

issn = "1590-8658",

publisher = "Elsevier",

number = "10",

}

van der Have, M, Belderbos, TDG, Fidder, HH, Leenders, M, Dijkstra, G, Peters, CP, Eshuis, EJ, Ponsioen, CY, Siersema, PD, van Oijen, MGH, Oldenburg, B 2014, 'Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study', Digestive and liver disease, vol. 46, no. 10, pp. 881-886. https://doi.org/10.1016/j.dld.2014.07.006

Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study. / van der Have, Mike; Belderbos, Tim D G; Fidder, Herma H et al.
In: Digestive and liver disease, Vol. 46, No. 10, 2014, p. 881-886.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Screening prior to biological therapy in Crohn's disease

T2 - adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

AU - van der Have, Mike

AU - Belderbos, Tim D G

AU - Fidder, Herma H

AU - Leenders, Max

AU - Dijkstra, Gerard

AU - Peters, Charlotte P

AU - Eshuis, Emma J

AU - Ponsioen, Cyriel Y

AU - Siersema, Peter D

AU - van Oijen, Martijn G H

AU - Oldenburg, Bas

PY - 2014

Y1 - 2014

N2 - BACKGROUND: Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended.AIMS: To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield.METHODS: A multicentre retrospective study was conducted in Crohn's disease patients in whom infliximab or adalimumab was started between 2000 and 2010. Screening included tuberculin skin test, interferon-gamma release assay or chest X-ray for tuberculosis. Extended screening included screening for tuberculosis and viral infections. Patients were followed until three months after ending treatment. Primary endpoints were opportunistic and serious infections.RESULTS: 611 patients were included, 91% on infliximab. 463 (76%) patients were screened for tuberculosis, of whom 113 (24%) underwent extended screening. Screening for tuberculosis and hepatitis B increased to, respectively, 90-97% and 36-49% in the last two years. During a median follow-up of two years, 64/611 (9%, 3.4/100 patient-years) opportunistic infections and 26/611 (4%, 1.6/100 patient-years) serious infections were detected. Comorbidity was significantly associated with serious infections (hazard ratio 3.94).CONCLUSIONS: Although screening rates for tuberculosis and hepatitis B increased, screening for hepatitis B was still suboptimal. More caution is required when prescribing biologicals in patients with comorbid conditions.

AB - BACKGROUND: Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended.AIMS: To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield.METHODS: A multicentre retrospective study was conducted in Crohn's disease patients in whom infliximab or adalimumab was started between 2000 and 2010. Screening included tuberculin skin test, interferon-gamma release assay or chest X-ray for tuberculosis. Extended screening included screening for tuberculosis and viral infections. Patients were followed until three months after ending treatment. Primary endpoints were opportunistic and serious infections.RESULTS: 611 patients were included, 91% on infliximab. 463 (76%) patients were screened for tuberculosis, of whom 113 (24%) underwent extended screening. Screening for tuberculosis and hepatitis B increased to, respectively, 90-97% and 36-49% in the last two years. During a median follow-up of two years, 64/611 (9%, 3.4/100 patient-years) opportunistic infections and 26/611 (4%, 1.6/100 patient-years) serious infections were detected. Comorbidity was significantly associated with serious infections (hazard ratio 3.94).CONCLUSIONS: Although screening rates for tuberculosis and hepatitis B increased, screening for hepatitis B was still suboptimal. More caution is required when prescribing biologicals in patients with comorbid conditions.

KW - Adalimumab

KW - Adult

KW - Anti-Inflammatory Agents

KW - Antibodies, Monoclonal

KW - Antibodies, Monoclonal, Humanized

KW - Crohn Disease

KW - Female

KW - Follow-Up Studies

KW - Guideline Adherence

KW - Hepatitis B

KW - Humans

KW - Infliximab

KW - Interferon-gamma Release Tests

KW - Linear Models

KW - Male

KW - Netherlands

KW - Opportunistic Infections

KW - Practice Guidelines as Topic

KW - Prevalence

KW - Retrospective Studies

KW - Tuberculin Test

KW - Tuberculosis

KW - Virus Diseases

U2 - 10.1016/j.dld.2014.07.006

DO - 10.1016/j.dld.2014.07.006

M3 - Article

C2 - 25081843

SN - 1590-8658

VL - 46

SP - 881

EP - 886

JO - Digestive and liver disease

JF - Digestive and liver disease

IS - 10

ER -

Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

Abstract

Keywords

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