[Screening for tuberculosis infection prior to medical therapy]

Area of Science:

• Immunology
• Infectious Diseases
• Rheumatology

Background:

• Tumour necrosis factor antagonists (anti-TNFα) are crucial for managing chronic inflammatory diseases.
• Anti-TNFα therapy is associated with a significant, over fourfold increase in tuberculosis (TB) reactivation risk.
• The reactivation risk varies based on clinical context and specific TNF-antagonist used.

Purpose of the Study:

• To outline the necessity of screening for latent TB in patients considered for anti-TNFα treatment.
• To recommend preventive strategies to mitigate TB reactivation in this patient population.

Main Methods:

• Evaluation of candidates for anti-TNFα treatment includes medical history focusing on exposure, chest X-ray, and interferon-γ release assays (IGRAs).
• Preventive chemotherapy is advised for individuals identified with latent TB infection.

Main Results:

• Systematic screening identifies individuals at risk for TB reactivation.
• Proactive administration of preventive chemotherapy before anti-TNFα initiation is expected to lower the progression rate from latent to active TB.

Conclusions:

• Implementing a comprehensive screening protocol for latent TB is essential for patients undergoing anti-TNFα therapy.
• Preventive chemotherapy significantly reduces the risk of developing active TB in individuals treated with anti-TNFα, ensuring safer treatment outcomes.