Tuberculosis in patients on TNFα inhibitor treatment in Latvia

During last decades an incidence of chronic inflammatory diseases is on the rise in the world. There is an increasing need for drugs, including TNFα inhibitors, to help patients suffering from these diseases. However risk of TB infection and disease increases in patients receiving TNF α therapy. In Latvia there are national guidelines implemented, determining screening for TB infection and disease before initiation and during therapy with TNFα therapy. Aim: To evaluate the conformity of actions by health care providers with national guidelines. Material and methods: Retrospective descriptive cross-sectional study. The data was collected through questionnaires, sent out to all 40 TB/pneumonologists in Latvia. They contain information from patient records of those that were diagnosed with LTBI and/or active TB before or during TNFα therapy, for the period of time from 01.01.2014 to 30.09.2015. Data from questionnaires was abstratcted by coding using binary numbers and letters in the computer program Microsoft Excel. Results: Active TB developed in 4 (3%) out of 136 patients receiving TNFα treatment. TB contact history was identified in 2 of 30 patients diagnosed with LTBI. PPD test was performed in 67 (49%) and IGRA test in 104 (77%) of TNFα treatment candidates, respectively. Majority of latently infected patients (97%) had received preventive treatment with isoniazid, however only 4 (13%) of 30 patients received recomended 9 months therapy. Conclusion: The overall conformity with national guidelines was good. Mostly both tests were not performed due to the logistic difficulties. Improvement of algorythm should be discussed.