Tuberculosis screening in prescribers of anti-tumor necrosis factor therapy in the European Union.
METHODS
Physician offices and hospital-based settings in 24 European Union countries.


OBJECTIVE
To assess the awareness of tuberculosis (TB) risk, performance of TB screening and factors predicting TB screening among prescribers of tumor necrosis factor alpha (TNF-α) agents.


METHODS
A total of 915 prescribers (441 rheumatologists, 266 gastroenterologists and 208 dermatologists) of anti-TNF agents participated in a 41-item survey between March and May 2010. Multivariate analyses were conducted to identify predictors of TB screening.


RESULTS
Overall, ≥88% of physicians  identified TB reactivation as an adverse effect associated with anti-TNF use. Self-reported TB screening ranged from 73% of gastroenterologists in the five foremost industrialized economies (G5) countries to 92% of rheumatologists in non-G5 countries. Factors predictive of TB screening included  rheumatology or gastroenterology specialty, higher awareness of TB reactivation as a risk, greater adherence to TB testing guidelines, larger caseloads of patients with severe disease, practicing in a major industrialized country and greater number of anti-TNF agents for which risk-related  information had been received.


CONCLUSIONS
Most physicians reported being aware of the attendant risk for reactivation of latent TB infection with anti-TNF treatments. Results suggest that distributing pertinent educational materials is an effective component of a risk minimization strategy  to promote TB screening among anti-TNF prescribers.
Abbott Laboratories, Abbott Park, Illinois 60064, USA. Meredith.Smith@abbott.com
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D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D001291:Attitude of Health Personnel; D001364:Awareness; D016009:Chi-Square Distribution; D002983:Clinical Competence; D000068800:Etanercept; D005060:Europe / Q000453:epidemiology; D005062:European Union; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D018124:Receptors, Tumor Necrosis Factor; D018570:Risk Assessment; D012307:Risk Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept