Greater Tb And Hepatitis B Screenings Among Ibd Patients On Dual Therapies Than Those On Immunosuppressive Monotherapy

Background: Patients with Inflammatory Bowel Disease (IBD) are often treated with biologic and/or immunosuppressive therapies to achieve and maintain remission. Dual therapies have been observed to reduce rates of hospitalization and surgeries among those with IBD, and are more beneficial when received earlier in the disease course. Long-term use of these therapies without appropriate screenings, however, can subject patients to vaccine-preventable illnesses. Current guidelines recommend screening for TB and Hepatitis B virus (HBV) prior to initiating immunosuppressive therapy. Our study aim was to evaluate the impact of dual-versus mono-therapies administration on the receipt of TB and HBV screening among IBD patients. Methods: Using electronic health records, we performed a retrospective review of IBD patients at an academic medical center over 6 months to evaluate the administration of TB and HCV screening between patients on dual biologic and immunosuppressive therapies and immunosuppressive monotherapy. All IBD patients were under the care of faculty gastroenterologists. Data regarding demographics, vaccination status, and biologic and immunosuppressive agents were compiled into a database while maintaining subject confidentiality. Statistical analysis was conducted using a 2-tailed Fisher's Exact Test with a significance set at P < 0.05. Results: Out of 141 total patients, 74 (52%) had received TB screening. Among the 14 (10%) patients who received dual therapies, 12 (86%) received TB screening. Among the 127 (90%) patients on immunosuppressive monotherapy, 62 (49%) received TB screening. There is a 1.8-fold absolute increase in TB screening among IBD patients on dual biologic and immunosuppressive therapies compared to immunosuppressive monotherapy (P = 0.010). Out of 141 total patients, 89 (63%) had received HBV screening. Among the 14 (10%) patients who received dual therapies, 13 (93%) received HBV screening. Among the 127 (90%) patients on immunosuppressive monotherapy, 76 (60%) received HBV screening. There is a 1.6-fold absolute increase in HBV screening among IBD patients on dual biologic and immunosuppressive therapies compared to immunosuppressive monotherapy (P = 0.018). Conclusions: Our data indicate that IBD patients on dual biologic and immunosuppressive therapies receive significantly more TB and HBV screening than those on immunosuppressive monotherapy. Though we are not exactly sure of the differential rates of screening between these 2 groups, potential reasons may include the gastroenterologist's lack of familiarity with immunization guidelines or the patient's concern for possible side effects. This study emphasizes the need for greater TB and HBV screening among IBD patients initiating immunosuppressive monotherapy, as there is a risk of disease reactivation among immunosuppressed patients. Reactivation of latent TB can lead to pulmonary TB, which is one of the world's most common fatal infections, while reactivation of HBV can lead to potentially fatal liver failure. Adhering to the recommended screening guidelines will hopefully reduce the morbidity and mortality related to vaccine-preventable illnesses among this population.