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. 2022 Nov;8(2):e002726.
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

George E Fragoulis  1   2 , Mrinalini Dey  3   4 , Sizheng Zhao  5 , Jan Schoones  6 , Delphine Courvoisier  7 , James Galloway  8   9 , Kimme L Hyrich  5   10 , Elena Nikiphorou  11   9
Affiliations

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 et al. RMD Open. 2022 Nov.

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.

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Conflict of interest statement

Competing interests: GEF: speaker fees/honoraria: Pfizer, UCB, Novartis, Abbvie, Aenorasis, Genesis. MD: None. SSZ: consulting fees: UCB. JS: none. DSC: none. JG: speaker fees/honoraria: Abbvie, Galapagos, Gilead, Janssen, Lilly, Novartis, Pfizer, UCB. Research funding: Abbvie, Astrazeneca, Galapagos, Gilead, Gritstone, Janssen, Moderna, Novovax, Pfizer. KH: honoraria from Abbvie; grant income from Pfizer and BMS. EN: speaker fees/honoraria: Celltrion, Pfizer, Sanofi, Gilead, Galapagos, AbbVie, Lilly, Fresenius. Research funding: Pfizer, Lilly.

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