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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands. Electronic address: M.vanderhave85@gmail.com.
authors.forename: Mike
authors.initials: M
authors.lastname: van der Have
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Tim D G
authors.initials: TD
authors.lastname: Belderbos
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Herma H
authors.initials: HH
authors.lastname: Fidder
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Max
authors.initials: M
authors.lastname: Leenders
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
authors.forename: Gerard
authors.initials: G
authors.lastname: Dijkstra
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Charlotte P
authors.initials: CP
authors.lastname: Peters
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Eshuis
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
authors.forename: Cyriel Y
authors.initials: CY
authors.lastname: Ponsioen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Oldenburg
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D000069285:Infliximab; D059425:Interferon-gamma Release Tests / Q000706:statistics & numerical data; D016014:Linear Models; D008297:Male; D009426:Netherlands; D009894:Opportunistic Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012189:Retrospective Studies; D014374:Tuberculin Test / Q000706:statistics & numerical data; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D014777:Virus Diseases / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000069285:Infliximab; D000068879:Adalimumab
keywords: Anti-TNF therapy; Inflammatory bowel disease; Opportunistic infections; Prevention