ADHERENCE TO PUBLISHED GUIDELINES ON TB SCREENING BEFORE THE START OF TREATMENT WITH BIOLOGICS IN GERMANY

A. Strangfeld, J. Listing, F. Hierse, A. ZinkEpidemiology Unit, German Rheumatism Research Centre, Berlin, GermanyObjectives: To examine how strictly the screening recommendations for latent tuberculosis (TB) are observed in Germany by rheumatologists treating RA patients with biologics.Methods: We conducted a survey of all rheumatological practices and outpatient clinics participating in the German biologics register RABBIT. The register has been implemented in 2001 and follows up RA patients with a new start of any of the licensed cytokine inhibitors. We surveyed 162 participating rheumatologists regarding their TB screening methods.Results: Ninety-five percent of the responders stated to be performing a TB-screening regularly in all patients before starting any treatment with biologics. Another 3% restricted screening to patients treated with one of the monoclonal antibodies, and 2% performed regular screening only in patients > 60 years of age.The majority of responders had started screening for TB in 2002 when first recommendations were published.Eighty percent conduct the intradermal tuberculin test (PPD) regularly and half of them consider a test result with an induration of ≥ 5 mm as positive. For 25% an induration wider than 10 mm is necessary to be considered a positive result.Ninety-six percent of the physicians stated to be arranging a chest x-ray as a matter of principle.Regarding medical history, most rheumatologists (92%) stated to always be asking for a previous TB disease, but only half of them asked for possible contacts with TB patients, TB disease in relatives or a relevant travel history regularly. Rheumatological units with a lower number of patients treated with biologics tended to be asking these questions less frequently.The majority of rheumatologists reported a frequency of 5-10% of patients tested positive for TB.Fifty-nine percent of the rheumatologists stated to be prescribing prophylactic treatment always in patients with positive skin test and 32% always in patients with positive x-ray. 15% of the rheumatologists stated to be prescribing prophylactic treatment only when both, the skin test and the x-ray, were positive.Conclusion: Even in specialised rheumatological care there is a variety of screening procedures and of the consequences taken. Deviation from the published recommendations was larger in units with few patients under biologics. Therefore i) recommendations should be harmonised and spread of information should be continued and ii) treatment with biologics should remain in the hands of experienced rheumatologists as the likelihood of knowing and following guidelines is higher in centres with many patients under biologics.References: Supported by a joint, unconditional grant from Wyeth Pharma GmbH, essex pharma GmbH, Amgen GmbH and Abbott GmbH & Co. KG.Citation: Ann Rheum Dis, volume 65, supplement II, year 2006, page 495Session: Rheumatic arthritis – other clinical aspects and comorbidity