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Patients on biotherapy are at risk for TB
Treatments using disease-modifying antirheumatic drugs (DMARDs), immunosuppressants and glucocorticoids have revolutionized the treatment of autoimmune diseases such as rheumatoid arthritis, Crohn's disease and psoriasis.
However, patients undergoing immunotherapy face an increased risk for tuberculosis. The immune system helps contain latent TB infection and prevent progression to active TB disease. One of the most common classes of DMARDs, TNF-α inhibitors, puts patients at a 9-fold increased risk of developing active TB (1).
To limit the risk of TB progression, global recommendations now include a screening test for TB infection for most patients receiving biotherapy (2–5).
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Reduce the risk of future complications
In addition to screening for TB at the onset of immunotherapy, retesting every 1–2 years for patients who have a new or recurring risk factor should be considered. Risk factors include living in or extended travel to an endemic country, TB exposure, or employment in a healthcare or congregate setting. Risk factors such as smoking, substance use disorders, diabetes, etc. should also be considered.
References:
- Lobue, P. and Menzies, D. Treatment of latent tuberculosis infection: An update. Respirology. 2010;15: 603-622.
- 2. Lewinsohn DM, et al. Official ATS/IDSA/CDC clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017;111-115.
- US CDC. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection — United States, 2010. MMWR 2010; 59, RR-5.
- World Health Organization. WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment. 2020.
- Fragoulis, GE, et al. 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2022;0:1–12.
- Diel, R, et al. Joint Statement (DZK, DGRh, DDG) on the Tuberculosis Risk with Treatment Using Novel Non-TNF-Alpha Biologicals. Pneumologie. 2021;75: 293–303
- Anastasopoulou, A, et al. Reactivation of tuberculosis in cancer patients following administration of immune checkpoint inhibitors: current evidence and clinical practice recommendations. J Immunotherapy Cancer 2019;7:239.
- Lin, C, et al. Tuberculosis infection following immune checkpoint inhibitor treatment for advanced cancer: a case report and literature review. Front. Immunol. 2023;14:1162190.