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The frequency of tuberculosis chemoprophylaxis prior to TNF-α inhibitor treatment, and the incidence tuberculosis infection using a two-step screening algorithm for latent tuberculosis infection: data from the BioRx.si registry
  1. Matija Tomšič,
  2. Žiga Rotar
  1. Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
  1. Correspondence to Dr Žiga Rotar, Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, Ljubljana 1000, Slovenia; ziga.rotar{at}revma.net

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Due to the well-established risk of latent tuberculosis infection (LTBI) reactivation, and its potentially devastating consequences in patients treated with tumour necrosis factor (TNF)-α inhibitors (anti-TNF), a low threshold for TB chemoprophylaxis is usually recommended.1 ,2 Conversely, TB chemoprophylaxis is time consuming, delays the initiation of required treatment, adds to the overall cost of treatment, and carries risk of adverse events in its own right.3 A screening algorithm able to safely reduce the frequency of TB chemoprophylaxis would be of great value.

Recently, Mariette et al4 showed that replacing the tuberculin skin test (TST) with interferon-γ release assays in their LTBI screening algorithm reduced the requirement for TB chemoprophylaxis from 45.2% to 27.3%, while there were no new cases of TB during the 1-year observation period.

In Slovenia, since 2002, a two-step LTBI screening algorithm is being used for all rheumatological patients who are candidates for anti-TNF. The LTBI screening is not repeated on a regular …

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