Fragoulis, George E, Dey, Mrinalini 
ORCID: 0000-0001-6858-4338, Zhao, Sizheng, Schoones, Jan, Courvoisier, Delphine, Galloway, James, Hyrich, Kimme L and Nikiphorou, Elena
(2022)
Systematic literature review informing the 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases.
RMD OPEN, 8 (2).
e002726-.
Abstract
<h4>Objective</h4>To conduct a systematic literature review (SLR) on the screening and prophylaxis of opportunistic and chronic infections in autoimmune inflammatory rheumatic diseases (AIIRD).<h4>Methods</h4>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.<h4>Exclusion criteria</h4>studies on postoperative infections, paediatric AIIRD, COVID-19, vaccinations and non-Εnglish literature. Study quality was assessed with Newcastle-Ottawa scale for non-randomised controlled trials (RCTs), RoB-Cochrane for RCTs, AMSTAR2 for SLRs.<h4>Results</h4>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 <i>Pneumocystis jirovecii</i>, prophylaxis treatment should be considered in patients treated with prednisolone ≥15-30 mg/day for >2-4 weeks.<h4>Conclusions</h4>Different screening and prophylaxis approaches are described in the literature, partly determined by individual patient and disease characteristics.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Autoimmune Diseases, Antirheumatic Agents, Therapeutics |
| Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 08 Feb 2023 11:59 |
| Last Modified: | 08 Feb 2023 11:59 |
| DOI: | 10.1136/rmdopen-2022-002726 |
| Open Access URL: | https://rmdopen.bmj.com/content/8/2/e002726 |
| Related URLs: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3168267 |
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