Meutstege, K. (2019) Outcome prevalence and predictors in screening prior to biologic IBD treatment in a low endemic setting. thesis, Medicine.
Full text available on request.Abstract
Background: Prior to the administration of biologics in inflammatory bowel disease, it is recommended to screen patients for tuberculosis(TB), Hepatitis B and Hepatitis C to prevent possible fatal (re)activation of these infections. In TB screening, Tuberculin Skin Tests(TST) and Interferon Gamma Release Assay(IGRA) are often seen as leading tools, yet they are less sensitive in immunosuppression and have poor predictive value in low endemic settings. Current strategies are demanding in budget and time in clinical setting in contrary to the use of anamnestic factors, which now have limited role in screening. Therefore, we examined the predictiveness of latent TB(LTBI) risks such as past exposure along with prevalence and distribution of screening outcome, in order to keep evaluating current strategies. Methods: We performed a single-centre study in a low endemic region. We retrospectively gathered 261 screening results with inclusion of every screened patient from July 2013 through June 2018. We analysed the association of TB exposure in the past(place of birth, travels, profession, etc.) and immunodeficiency(immunosuppression, malnourishment, comorbidities) with positivity of LTBI diagnosis, using Fischer’s Exact Tests. Results: There were 24(9%) positive findings in the investigated period, of which 17(6%) patients were diagnosed with LTBI and received eradication treatment. Five cases of resolved HBV and 2 cases of resolved HCV did not require antiviral treatment. Endemic origin (Incidence>50/100.00) and undernourishment(BMI<20) were significantly associated with LTBI diagnosis. Conclusions: This study - focusing on results of a screening program prior to biologics treatment in a large IBD population in a rural setting - showed low rates of positive findings requiring treatment, Even more when taken into account the minimal thresholds used to diagnose and treat for LTBI in this context. In future strategies, risk inventory with quick and representative patient traits could be alternatives for tests like TST and IGRA.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Supervisor: and Mensink, Dr. P.B.F. and Institution: Medisch Spectrum Twente, Enschede Department: G |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:47 |
| Last Modified: | 25 Jun 2020 10:47 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/819 |
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