Screening for tuberculosis and hepatitis B prior to the initiation of anti-tumor necrosis therapy

Background: Since the introduction of infliximab, anti-tumor necrosis factor alpha (anti-TNF-α) agents have been used with increasing frequency for the treatment of inflammatory bowel disease (IBD). Reactivation of latent Mycobacterium tuberculosis (TB) soon became recognized as a complication of therapy. More recently, reactivation of hepatitis B while on anti-TNF therapy has been documented. The aim of this study was to assess the adherence to screening for latent TB and hepatitis B by gastroenterologists prior to initiation of an anti-TNF. Methods: This is a retrospective analysis of all patients with IBD treated with an anti-TNF at a large urban academic hospital. In our population, 65% of patients were screened for latent TB prior to the initiation of anti-TNF therapy, while 25% of patients were screened for hepatitis B. Results: Failure to screen for latent TB was strongly correlated with prior exposure to an anti-TNF (odds ratio [OR]: 5.3; P < 0.0001) and initiation of treatment prior to 2006 (OR: 5.8; P < 0.0001). Failure to screen for hepatitis B was associated with lack of an abnormal alanine aminotransferase (OR: 2.6; P = 0.005) and treatment prior to 2010 (OR: 3.3; P = 0.02). Providers who had been in practice longer were less likely screen for TB or hepatitis B. Conclusions: The rate of screening for both latent TB and hepatitis B in this study was inadequate. While the rate of screening is increasing, further systems improvements and physician education is needed.