Systematic literature review informing the 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

Abstract

ObjectiveTo conduct a systematic literature review (SLR) on the screening and prophylaxis of opportunistic and chronic infections in autoimmune inflammatory rheumatic diseases (AIIRD).MethodsSLR (inception-12/2021) based on the following search domains: (1) infectious agents, (2) AIIRD, (3) immunosuppressives/immunomodulators used in rheumatology, (4) screening terms and (5) prophylaxis terms. Articles were retrieved having the terms from (1) AND (2) AND (3) plus terms from (4) OR(5). Databases searched: PubMed, Embase and Cochrane Library. Exclusion criteria: studies on postoperative infections, paediatric AIIRD, COVID-19, vaccinations and non-Εnglish literature. Study quality was assessed with Newcastle-Ottawa scale for non-randomised controlled trials (RCTs), RoB-Cochrane for RCTs, AMSTAR2 for SLRs.ResultsFrom 5641 studies were retrieved, 568 full-text articles were assessed for eligibility, with 194 articles finally included. For tuberculosis, tuberculin skin test (TST) is affected by treatment with glucocorticoids and conventional synthetic disease modifying anti-rheumatic drugs (DMARDs) and its performance is inferior to interferon gamma release assay (IGRA). Agreement between TST and IGRA is moderate to low. For hepatitis B virus (HBV): risk of reactivation is increased in patients positive for hepatitis B surface antigen. Anti-HBcore positive patients are at low risk for reactivation but should be monitored periodically with liver function tests and/or HBV-viral load. Risk for Hepatitis C reactivation is existing but low in patients treated with biological DMARDs. ForPneumocystis jirovecii, prophylaxis treatment should be considered in patients treated with prednisolone ≥15–30 mg/day for >2–4 weeks.ConclusionsDifferent screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics.

Chronic and opportunistic infections in patients with immuno-inflammatory rheumatic diseases: screening and prevention issues (based on the materials of the EULAR recommendations)

“…Рабочей группой EULAR впервые представлен перечень рекомендаций по скринингу и профилактике ХОИ при ИВРЗ, сформированный на основе систематического обзора, выполненного группой экспертов в области ревматологии, пульмонологии и инфекционных заболеваний [58]. В то же время эти рекомендации следует рассматривать через призму национальных руководств, учитывающих региональные факторы риска, особенности течения, диагностики, терапии и профилактики ХОИ.…”

On the issue of screening and prevention of chronic and opportunistic infections in rheumatology

“…ЛП -ложноположительная; ЛО -ложноотрицательная; ВЗС -воспалительные заболевания суставов; РА -ревматоидный артрит; МТ -метотрексат; ОР -относительный риск; ОШ -отношение шансов. 1 -суточная доза ГК в эквиваленте по преднизолону; 2 -93/248 больных имели воспалительное заболевание кишечника.…”

“…ЛП -false positive; ЛО -false negative; ВЗС -inflammatory diseases of the joints; РА -rheumatoid arthritis; МТ -methotrexate; ОР -relative risk; ОШ -odds ratio. 1 -daily dose of glucocorticoids in the equivalent of prednisone; 2 -93/248 patients had inflammatory bowel disease.…”

“…В связи с этим, группой экспертов Европейского альянса ревматологических ассоциаций (EULAR) был выполнен систематический обзор литературы [1] и на его основе подготовлены рекомендации, посвящённые процедурам скрининга и мерам профилактики наиболее часто встречающихся ХОИ в рамках ИВРЗ [2]. В то же время авторы признают, что создание единого руководства по скринингу и профилактике ХОИ является сложной задачей из-за различий в регионе проживания, типе ИВРЗ и связанном с ним риске, получаемой противоревматической терапии, и других факторах, которые создают дополнительные проблемы, в частности, возраст и сопутствующие заболевания.…”

Screening, prophylaxis, and challenges: Tumor necrosis factor inhibitors and latent tuberculosis infection nexus in rheumatology

“…Under such conditions, preventing LTBI reactivation becomes an important part of TNFi application, mainly including two aspects: LTBI screening and preventive anti‐tuberculosis treatment. However, although recommendations for LTBI screening and prophylaxis in patients planning to be treated with TNFi have been proposed in several countries and regions, 7,8 few patients still experience the reactivation of LTBI and poor prognosis, including both positive and negative LTBI testing 9 . Therefore, it is anticipated to address current issues and conduct further research to optimize recommendations.…”