The risk of tuberculosis in patients treated with TNF antagonists

Abstract

Over the last 12 years, TNF antagonists have been successfully used for the treatment of numerous patients afflicted by chronic inflammatory disorders. However, data from clinical trials and registries have shown that patients treated with these biologics have an increased risk of reactivating latent TB. The fact that TNF plays a role in the immune cell response and, more specifically, in maintenance of granuloma integrity is the accepted grounds for reactivation of TB following inhibition of TNF. Appropriate screening of latent TB and proper management of cases substantially reduces the incidence of active TB. Nevertheless, debate still remains regarding the value of the tuberculin skin test and IFN-γ-release assays as diagnostic tools, and treatment across guidelines and recommendations. This largely reflects differences in background population.

Keywords::

• adalimumab
• ankylosing spondylitis
• certolizumab
• etanercept
• golimumab
• granuloma
• IGRA
• infliximab
• isoniazid
• latent TB
• Mycobacterium tuberculosis
• rheumatoid arthritis
• rifampicin
• TB
• tuberculin skin test
• tumor necrosis factor

Financial & competing interests disclosure

Juan J Gómez-Reino is on the Advisory Boards of Schering-Plough, Wyeth, MSD, Bristol-Meyers Squibb and Roche, and has received lecture fees from Abbott Laboratories, Wyeth, MSD, Roche, Bristol-Meyers Squibb and Schering-Plough. This work is partially supported by RIER from the Instituto de Salud Carlos III, Spain. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.