Tuberculosis Screening in Prescribers of Anti-tumor Necrosis Factor Therapy in the European Union

Setting: Physician offices and hospital-based settings in 24 European Union countries.

Objectives: To assess the awareness of tuberculosis (TB) risk, performance of TB screening and factors predicting TB screening among prescribers of tumor necrosis factor alpha (TNF-α) agents.

Methods: A total of 915 prescribers (441 rheumatologists, 266 gastroenterologists and 208 dermatologists) of anti-TNF agents participated in a 41-item survey between March and May 2010. Multivariate analyses were conducted to identify predictors of TB screening.

Results: Overall, ≥88% of physicians identified TB reactivation as an adverse effect associated with anti-TNF use. Self-reported TB screening ranged from 73% of gastroenterologists in the five foremost industrialized economies (G5) countries to 92% of rheumatologists in non-G5 countries. Factors predictive of TB screening included rheumatology or gastroenterology specialty, higher awareness of TB reactivation as a risk, greater adherence to TB testing guidelines, larger caseloads of patients with severe disease, practicing in a major industrialized country and greater number of anti-TNF agents for which risk-related information had been received.

Conclusions: Most physicians reported being aware of the attendant risk for reactivation of latent TB infection with anti-TNF treatments. Results suggest that distributing pertinent educational materials is an effective component of a risk minimization strategy to promote TB screening among anti-TNF prescribers.