Systematic literature review informing the 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases

George E Fragoulis; Mrinalini Dey; Sizheng Zhao; Jan Schoones; Delphine Courvoisier; James Galloway; Kimme L Hyrich; Elena Nikiphorou

doi:10.1136/rmdopen-2022-002726

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. 2022 Nov;8(2):e002726. doi: 10.1136/rmdopen-2022-002726.

Authors

George E Fragoulis^{1

2}, Mrinalini Dey^{3

4}, Sizheng Zhao⁵, Jan Schoones⁶, Delphine Courvoisier⁷, James Galloway^{8

9}, Kimme L Hyrich^{5

10}, Elena Nikiphorou^{11

9}

Affiliations

¹ Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, First Department of Propaedeutic and Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
² Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.
³ Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
⁴ Department of Rheumatology, Countess of Chester Hospital NHS Foundation Trust, Chester, UK.
⁵ Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK.
⁶ Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands.
⁷ Division of Rheumatology, Geneva University Hospitals, Geneve, Switzerland.
⁸ Centre for Rheumatic Diseases, King's College London, London, UK.
⁹ Rheumatology Department, King's College London, London, UK.
¹⁰ National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK.
¹¹ Centre for Rheumatic Diseases, King's College London, London, UK enikiphorou@gmail.com.

Abstract

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-Εnglish 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.

Keywords: Antirheumatic Agents; Autoimmune Diseases; Therapeutics.

Publication types

Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adult
Antirheumatic Agents* / adverse effects
COVID-19* / diagnosis
COVID-19* / prevention & control
Child
Hepatitis B virus
Humans
Opportunistic Infections* / diagnosis
Opportunistic Infections* / etiology
Opportunistic Infections* / prevention & control
Rheumatic Diseases* / complications
Rheumatic Diseases* / drug therapy

Substances

Antirheumatic Agents