755. Clinical Adherence to Latent Tuberculosis Screening Recommendations in Adults with Inflammatory Bowel Disease (IBD) Prior to Biologic Therapy

Abstract

BackgroundBiological agents have become increasingly common in the treatment of immune-mediated illnesses. Their use, however, is associated with an increased risk of progression from latent to active tuberculosis (TB) infection. The American Thoracic Society (ATS) recommends both a tuberculin skin test (TST) and an interferon gamma release assay (IGRA) be conducted to screen for latent TB prior to initiation of biologic therapy. We examined the adherence to these recommendations for adults with inflammatory bowel disease (IBD) in the Calgary region of Alberta.MethodsIn this retrospective cross-sectional study, we used the Alberta Health Services’ Sunrise Clinical Manager and Netcare databases to identify IBD patients initiated on biologic therapy (age >18 years) in Calgary, Alberta between 2008 and 2018. Socio-demographic and clinical characteristics of patients were described. Linear and logistic regression models were constructed to identify factors associated with screening. All analyses were conducted using Stata 15.0 (University of London, UK).ResultsThere was a total of 247 identified cases (48.18% female). Of these 96 were Ulcerative Colitis and 151 Crohn’s Disease. The mean age was 39.5 (14.8 SD). There was a total of 210 (85%) who had documented screening with the TST and nine (3.4%) with the IGRA. In a multivariable analysis, factors associated with latent TB screening were age and outpatient setting at the time of screen. Six patients (2.43%) had positive screens and four of those six were treated for latent TB infection.ConclusionTST remains the predominant screening method for latent TB infection although the ATS recommends both IGRA and TST prior to biologic therapy. Screening varied with age and higher rates were noted in those evaluated as outpatients compared with inpatients. Further work is needed to evaluate the barriers to screening and to improve access to latent TB screening particularly in the inpatient setting.Disclosures All authors: No reported disclosures.