P033 Optimising management of latent tuberculosis prior to biologics (OPTITAB)

Abstract Background/Aims The British Society for Rheumatology (BSR) recommend that patients with inflammatory arthritis should be tested for tuberculosis (TB) (tuberculin skin test or interferon gamma release assay) as part of biologic pre-treatment screening. Local practice was inconsistent, so we used a multi-pronged approach to understand the issues and auditing practice. We intended to improve the management of patients with latent TB and therefore initiated OPTITAB - Optimisation of latent TB management in inflammatory arthritis starting biologics. Methods A quality improvement program was formulated and approved locally, including baseline audit. We collected retrospective data for control patients and patients who had positive T spots. The primary aim was to understand the management of these patients between decision to start a biologic to the actual first administration. Anonymised routine data was collected and analysis performed using MS Excel. Results We analysed data on 28 control patients and 20 patients with positive T spot Control group: Median age was 53.5 years (range 21-80 years), 20 patients were female. 15 patients had rheumatoid arthritis (RA), 6 psoriatic arthritis (PsA), 6 ankylosing spondylitis (AS), 1 enteropathic arthritis. Methotrexate was the DMARD most frequently used. Leflunomide, hydroxychloroquine, sulfasalazine were also used. 4 patients had oral steroids, 7 had IM depomedrone 120 mg injections (total of 10 injections). Only 4 out of 28 patients had full screening as per BSR recommendation, including IGRA testing. 1 patient did not start treatment, 21 patients had documented dates. Median time from clinical decision to start biologic and first administration was 41 days (mean 39). 1 patient had a positive unactioned IGRA, and they subsequently developed TB following biologic initiation. The patient had quadruple TB therapy and recovered fully. Positive T spot group: Median age was 57.5 years, 11 of 20 patients were female. 12 patients had RA, 4 PsA and 4 AS. There were 28 co-morbidities in 19 patients. MTX and HCQ were the most frequently used DMARDs in combination, MTX monotherapy was used in 12 patients. 3 patients did not start biologics. In 2 patients, the date for start of biologics was not documented. In the remaining 15 patients, median delay starting biologics was 157 days (mean 146 days). 9 patients had IM or oral corticosteroid rescue. 1 patient declined latent TB treatment and biologics. For 1 patient a clinical decision was made not to treat latent TB. 4 patients had INH monotherapy, and 14 a combination of rifampicin and INH. 1 patient died from unrelated infective causes; none developed TB. Conclusion Patients with positive T spot have inordinate delays in care and lack a structured approach. Development and implementation of efficient pathways are needed for this cohort of patients. Disclosure H. Bunting: None. S. Manderson: None. A. McCallum: None. S. Dubey: None.