P002 Refining pre-immunosuppression protocols: a national survey and regional quality improvement project focusing on latent tuberculosis infection

Abstract Background/Aims National guidance mandates latent tuberculosis infection (LTBI) screening pre-biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) but practice variation in screening pre-conventional synthetic disease-modifying antirheumatic drugs (csDMARDs)/high dose prednisolone or at the point of switching b/tsDMARDs. Screening for LTBI in patients on immunosuppression may be falsely negative. We aimed to devise a standardised pre-immunosuppression screening approach using available evidence triangulated with a survey of local and national colleagues’ practice, discussion with local infection and microbiology colleagues, and review of rates of LTBI detection in our regional patient cohorts. Methods A literature search was used to devise a pre-immunosuppression screening questionnaire (SurveyMonkey) which was distributed through regional and national rheumatology networks and locally to non-rheumatological colleagues prescribing DMARDs 01/03/2024-31/03/2024. This information was collated with local ID and Microbiology advice to propose a standardised pre-immunosuppression screening protocol. A regional quality improvement project (QIP) was registered to analyse results of QuantiFERON-TB tests from Rheumatology patients in South Yorkshire over a six-month period mapping results to three possible treatment timepoints: pre-csDMARDs/high dose steroid, pre-1st and pre-switching b/tsDMARDs, using SPSS. Results 40 survey responses were received. 45% of responders routinely screened for LTB pre-csDMARDs and 23% pre-high dose prednisolone compared to 100% pre-bDMARDs. When switching b/tsDMARDs, 82% of participants would not rescreen for LTBI. Regional QIP results (Table 1) demonstrate no statistically significant difference in positive LTBI results between groups with statistically similar demographic and TB risk data in all cohorts. There were no newly identified LTBIs in patients switching b/tsDMARDs. Conclusion We used available evidence, survey data, discussion with MDT colleagues and national guidance to implement a standardised screening process for LTBI. The change is to screen at the decision to start csDMARDs/high dose prednisolone i.e., earlier in the patient treatment pathway with re-screening at further treatment changes only if new risk factors for LTBI are identified. QuantiFERON-TB data analysis showed no difference in LTBI detection relating to time of testing along patients’ treatment journey, accepting our small sample size. More, ideally longitudinal, patient data is needed to deploy evidence-based and rational screening protocols for LTBI in increasingly complex rheumatological medicine regimes whilst minimising unnecessary and costly testing. Disclosure S. Sharrack: Grants/research support; Recipient of NIHR Leeds BRC Clinical Doctoral Fellowship. M. Cox: None. S. Carter: None. D. Cohen: None. P. Collini: None. L. Dunkley: None. H. Umair: None. J. Jade: None. J.R. Maxwell: None. M. Raza: None. T. Nadin: None. R. Smith: None. R.S. Tattersall: None. C.A. Zollinger-Read: None. M. Akil: None.