Latent TB infection screening in patients with HS may be unnecessary
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Latent tuberculosis infection screening in patients with hidradenitis suppurativa who are treated with TNF alpha inhibitors may be unnecessary, according to a letter published in the Journal of the American Academy of Dermatology.
Patients with hidradenitis suppurativa (HS) who take TNF alpha inhibitors (TNFIs) have a TB reactivation risk, so latent tuberculosis infection (LTBI) screening before TNFI treatment is suggested.
“It has become relatively common to screen patients for latent tuberculosis intermittently after starting them on biologic medication,” corresponding author Anthony Fernandez, MD, PhD, assistant clinical professor at Cleveland Clinic Lerner College of Medicine, told Healio. “In fact, a significant percentage of clinicians screen for latent tuberculosis in such patients annually, and this strategy is even recommended by professional organizations and mandated by some insurance companies for annual biologic medication approval.”
Researchers identified HS patients treated for 3 or more months with a biologic and two or more LTBI test results from 2007 to 2019. A retrospective review of medical records was performed for patients with positive or indeterminate QuantiFERON-TB Gold (QFT) test results.
Of 170 patients, 72 were treated with more than one biologic (average, 1.7 biologics per patient), and 64.7% received one or more other immunosuppressive agents; 143 patients (84.1%) had only negative QFT results, 18 (10.6%) had one or more indeterminate results, and nine (5.3%) had one or more positive results.
“TB reactivation risk in patients receiving TNFIs is well established,” Ariana Ellis, BS, of Northeast Ohio Medical University and department of dermatology, Cleveland Clinic, and colleagues wrote in the study. “Despite this, only four patients (2.4%) in our cohort converted to a positive QFT following biologic initiation.”
The results suggest that focusing repeat LTBI screening in patients with new TB exposure risk factors may be more beneficial.
“Our results suggest that repeat screening of all HS patients on biologics has low value and adds unnecessary costs to the care of these patients,” Fernandez said. “Certainly, there are some patients and scenarios where repeat screening for latent tuberculosis is warranted and important. We believe more work needs to be done to determine who those patients are and situations where the benefits of rescreening outweigh the risks and costs.” – by Erin T. Welsh
Disclosures: Fernandez reports receiving research support from Mallinckrodt, Corbus, Pfizer and Novartis and honorarium from AbbVie, Novartis, UCB and Mallinckrodt for consulting, advisory board participation and speaking. The other authors report no relevant financial disclosures.