Wie sicher ist das Infektions-Screening vor einer Biologika-Therapie?

Zusammenfassung

Biologika haben in der Therapie unterschiedlicher rheumatisch entzündlicher Erkrankungen einen hohen Stellenwert und werden zunehmend eingesetzt. Für fast alle Biologika konnte eine signifikante Erhöhung des Infektionsrisikos nachgewiesen werden. Die Fachinformationen der betreffenden Medikamente sowie Fachgesellschaften sprechen daher Empfehlungen zum Infektions-Screening aus. Untersuchungen zum Infektions-Screening umfassen Anamnese, körperliche Untersuchung, Laborparameter und apparative Untersuchungen. Je nach Biologikum sollte unter anderem ein Screening auf Tuberkulose, auf Hepatitis-B-Virus-Infektion und seltener auf Hepatitis-C-Virus-Infektion erfolgen, zumal für Tuberkulose und Hepatitis B Empfehlungen zur präemptiven Therapie bestehen. Zum Tuberkulose-Screening werden der Tuberkulin-Hauttest und die Inter feron-gamma- release-Assays, zum Virus hepatis-Screening serologische Untersuchungen eingesetzt. Die vorliegende Arbeit beschäftigt sich mit der Effektivität der Untersuchungen zur Detektion einer latenten Infektionserkrankung mit Reaktivierungs risiko und ihrer Tauglichkeit als Screening-untersuchung vor dem Hintergrund der aktuellen Literatur und fasst abschließend die relevanten Empfehlungen zusammen.

Summary

Biological agents have a high value and are widely used for the treatment of autoimmune diseases. For almost all of them an increased risk of infections could be demonstrated. The respective prescribing information and medical societies issue recommendations on screening for infections. Diagnostic work-up include medical history, physical examination, laboratory examinations, and further procedures. Depending on the biological agent, screening for tuberculosis, for hepatitis-B-virus infection, and in particular cases hepatitis-C-virus infection should be performed, the more so as recommendations for preemptive therapy of tuberculosis and hepatits-B-virus infection exist. To screen for tuberculosis the tuberculin skin test and interferon-gamma-release assays are used, and to screen for virus hepatitis serological examinations. This article highlights the performance of these tests to detect latent infections with a risk of reactivation, and their suitability as a screening test, taking into account the current literature. Finally, relevant recommendations are summarized.

Schlüsselwörter

Infektions-Screening - Biologika - Tuberkulose - Virushepatitis

Keywords

Screening for infections - biological agents - tuberculosis - viral hepatitis

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