P774 Low adhesion to latent tuberculosis (TB) screening recommendations in inflammatory bowel disease (IBD) patients: Results of the INFEII registry of GETECCU
Authors: Zabana Abdo Y , de Francisco R , Rodríguez-Lago I , Chaparro M , Gomollón F , Piqueras M , Llaó J , Sicilia B , Domènech E , García-Bosch O , de Castro L , Calvet X , Morales V , Rivero M , Lucendo A J , Navarro P , Márquez L , Busquets D , Guardiola J , Gordillo J , Iglesias E , Beltrán B , Sesé E , Ferreiro-Iglesias R , Francisco M , Pajares R , Algaba A , Vicente R , Benítez O , Aceituno M , Riestra S , Rodríguez-Pescador A , Gisbert J P , Arroyo M T , Mena R , Sáinz E , Arias-García L , Mañosa M , Navarro M , Sanromán L , Villória A , Delgado-Villena P , García M J , Angueira T , Mínguez M , Murciano F , Arajol C , Esteve M 
Published: January 2020

Abstract

Background
INFEII registry (ClinicalTrials.gov: NCT02904590) is a prospective study promoted by GETECCU to determine the incidence and risk factors of infection in an inception cohort of IBD patients. Despite preventive measures and recommendations of scientific societies, TB remains a problem in patients with IBD treated with immunosuppressants (IMM) and biologics.

AIMS
To asses: (1) the screening of TB performed at the time of inclusion of a patient in the INFEII registry, (2) the incidence of latent TB; and (3) compliance with national and European recommendations.

Methods
A longitudinal prospective study of incident cases with IBD, initiated in October 2016 and with a planned follow-up of 5 years. In September 2019, INFEII registry had 1241 patients from 28 centres throughout Spain. The study protocol determines the mandatory fulfilment of TB screening in every patient, leaving to the centre the freedom of decision on what procedures to perform. Guidelines recommend a mandatory study before starting immunosuppression, especially with biological treatment, using the combination of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) or at least one TST with a booster test1,2.

Results
Of the 1241 patients 233 (19%) had no screening, 494 (40%) had one [TST 158, IGRA 299, thorax-X-ray 37], 288 (23%) two [TST + IGRA 87, IGRA + thorax-X-ray 130, TST + thorax-X-ray 30, TST + booster 41], 128 (10%) three [TST + IGRA + thorax-X-ray 65, TST + booster + IGRA 23, TST + booster + thorax-X-ray 40] and 98 (7.9%) the four tests [TST + booster + IGRA + thorax-X-ray]. 486 patients (48%) receive pharmacological immunosuppression (172 IMMS, 195 biologics, 119 COMBO) and from them 198 (41%) followed the guidelines recommendation (131 TST and IGRA and 118 TST-booster), 245 (50%) had some method for TB screening [TST 43, IGRA 112, thorax-X-ray 15, IGRA + thorax-X-ray 57, TST + thorax-X-ray 18] and 43 patients (8.8%) had no screening. With the baseline screening, latent TB was detected in 134 patients (13%), 63 (47%) receiving anti-TB chemotherapy. In patients initiating immunosuppression, latent TB was detected in 35 cases [of which 28 received prophylaxis but 7 under IMM did not]. Active TB was detected in 4 cases: 2 during baseline screening, one without screening and one with negative screening (negative TST and IGRA, without booster receiving biological treatment).

Conclusion
Despite TB in IBD is a relevant problem, there is ample room for improvement for the implementation of mandatory minimum screening recommendations, even in prospective protocolised projects.

References