¿Cómo realizamos el cribado de infección tuberculosa latente en pacientes candidatos a terapias biológicas en España? Una encuesta multidisciplinar / Screening for Latent Tuberculosis Infection in Patients who are Candidate for Biological Therapies in Spain? A Multidisciplinary Survey

Introducción: El tratamiento con terapias biológicas aumenta la incidencia de enfermedad tuberculosa. La implementación sistemática del cribado de la infección tuberculosa latente en pacientes que van a recibir estas terapias ha conseguido reducir el riesgo de desarrollarla. En 2016 se publicó en España el Documento de consenso sobre la prevención y el tratamiento de la tuberculosis en pacientes candidatos a tratamiento biológico. El objetivo principal del estudio fue evaluar la adherencia al mismo. Métodos: Estudio multicéntrico, descriptivo, observacional en forma de encuesta anónima online, difundida entre las diferentes sociedades médicas que trabajan con biológicos. Resultados: Se recibieron 747 respuestas. La mayoría de los encuestados realizaba el cribado en el momento adecuado y con la indicación correcta (93,7%). Solo un 36,6% de los encuestados solicitaba las pruebas diagnósticas adecuadas, mientras que el 56,3% acertaron las indicaciones de quimioprofilaxis. Hasta el 96% conocía las pautas de quimioprofilaxis recomendadas, mientras que solo el 63,9% las iniciaba en el momento adecuado. La especialidad con más participación y que más realizaba el cribado de infección tuberculosa latente fue reumatología (54%). En la mayoría de los casos, los neumólogos participaban como consultores. Conclusiones: Este estudio pone de manifiesto un bajo grado de adherencia a las recomendaciones, realizando un cumplimiento aceptable el 56% de los encuestados. Enfatizando en las pruebas diagnósticas adecuadas y en el algoritmo diagnóstico de infección tuberculosa latente, se podría reducir aún más la incidencia de enfermedad tuberculosa en los pacientes que van a recibir terapias biológicas

Introduction: Treatment with biological therapies increases the incidence of tuberculous disease. The introduction of systematic screening for latent tuberculosis infection in patients who are to receive these therapies has reduced this risk. In 2016, the consensus document on the prevention and treatment of tuberculosis in patients who are candidates for biological treatment was published in Spain. The main objective of this study was to evaluate adherence to these guidelines. Methods: Multicenter, descriptive, observational study via an anonymous online survey sent to medical societies involved in biologics. Results: We received 747 responses. Most respondents performed screening at the right time in the right patients (93.7%). Only 36.6% of respondents requested the appropriate diagnostic test, while 56.3% correctly recommended chemoprophylaxis. Up to 96% were familiar with the recommended chemoprophylaxis regimens, while only 63.9% initiated them at the right time. The specialist area that participated most and screened most patients for latent tuberculosis infection was rheumatology (54%). In most cases, pulmonologists were involved in an advisory capacity. Conclusions: This study shows poor overall adherence to recommendations, with only 56% of respondents reporting appropriate compliance. The incidence of tuberculous disease in patients who are to receive biological therapies could be reduced further by emphasizing the importance of the right diagnostic test and use of the diagnostic algorithm for latent tuberculosis infection

Screening for Latent Tuberculosis Infection in Patients who are Candidate for Biological Therapies in Spain? A Multidisciplinary Survey. / ¿Cómo realizamos el cribado de infección tuberculosa latente en pacientes candidatos a terapias biológicas en España? Una encuesta multidisciplinar.

INTRODUCTION: Treatment with biological therapies increases the incidence of tuberculous disease. The introduction of systematic screening for latent tuberculosis infection in patients who are to receive these therapies has reduced this risk. In 2016, the consensus document on the prevention and treatment of tuberculosis in patients who are candidates for biological treatment was published in Spain. The main objective of this study was to evaluate adherence to these guidelines. METHODS: Multicenter, descriptive, observational study via an anonymous online survey sent to medical societies involved in biologics. RESULTS: We received 747 responses. Most respondents performed screening at the right time in the right patients (93.7%). Only 36.6% of respondents requested the appropriate diagnostic test, while 56.3% correctly recommended chemoprophylaxis. Up to 96% were familiar with the recommended chemoprophylaxis regimens, while only 63.9% initiated them at the right time. The specialist area that participated most and screened most patients for latent tuberculosis infection was rheumatology (54%). In most cases, pulmonologists were involved in an advisory capacity. CONCLUSIONS: This study shows poor overall adherence to recommendations, with only 56% of respondents reporting appropriate compliance. The incidence of tuberculous disease in patients who are to receive biological therapies could be reduced further by emphasizing the importance of the right diagnostic test and use of the diagnostic algorithm for latent tuberculosis infection.