TY - JOUR
T1 - Systematic literature review informing the 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases
AU - Fragoulis, George E
AU - Dey, Mrinalini
AU - Zhao, Sizheng
AU - Schoones, Jan
AU - Courvoisier, Delphine
AU - Galloway, James
AU - Hyrich, Kimme L
AU - Nikiphorou, Elena
N1 - Funding Information:
There are, however, also important strengths to this SLR. This is the first registered SLR in the field of rheumatology addressing this topic and forming the basis for EULAR recommendations. This was a systematic review led by a TF of multiple experts from across not just rheumatology, but also infectious diseases and pulmonology, as part of the attempt to ensure information was retrieved on all relevant pathogens and screening and prophylaxis practices in routine clinical settings across countries. Also, an expert librarian (JS) supported the search strategy and undertook the database searches. The scoping review was also supported by the librarian and the methodologists and informed the main SLR, ensuring this was focused and pragmatic.
Publisher Copyright:
©
PY - 2022/11/2
Y1 - 2022/11/2
N2 - Objective To conduct a systematic literature review (SLR) on the screening and prophylaxis of opportunistic and chronic infections in autoimmune inflammatory rheumatic diseases (AIIRD). Methods SLR (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-ηnglish literature. Study quality was assessed with Newcastle-Ottawa scale for non-randomised controlled trials (RCTs), RoB-Cochrane for RCTs, AMSTAR2 for SLRs. Results From 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. For Pneumocystis jirovecii, prophylaxis treatment should be considered in patients treated with prednisolone ≥15-30 mg/day for >2-4 weeks. Conclusions Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics.
AB - Objective To conduct a systematic literature review (SLR) on the screening and prophylaxis of opportunistic and chronic infections in autoimmune inflammatory rheumatic diseases (AIIRD). Methods SLR (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-ηnglish literature. Study quality was assessed with Newcastle-Ottawa scale for non-randomised controlled trials (RCTs), RoB-Cochrane for RCTs, AMSTAR2 for SLRs. Results From 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. For Pneumocystis jirovecii, prophylaxis treatment should be considered in patients treated with prednisolone ≥15-30 mg/day for >2-4 weeks. Conclusions Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics.
KW - Adult
KW - Humans
KW - Child
KW - COVID-19/diagnosis
KW - Antirheumatic Agents/adverse effects
KW - Hepatitis B virus
KW - Opportunistic Infections/diagnosis
KW - Rheumatic Diseases/complications
UR - http://www.scopus.com/inward/record.url?scp=85141139490&partnerID=8YFLogxK
U2 - 10.1136/rmdopen-2022-002726
DO - 10.1136/rmdopen-2022-002726
M3 - Review article
C2 - 36323488
SN - 2056-5933
VL - 8
JO - RMD Open
JF - RMD Open
IS - 2
M1 - e002726
ER -
