Tuberculosis and interleukin blocking monoclonal antibodies: Is there risk?

Area of Science:

• Immunology
• Infectious Diseases
• Pharmacology

Background:

• Tumor necrosis factor (TNF)-blocking drugs are known to increase tuberculosis (TB) risk, necessitating Mtb screening.
• Newer monoclonal antibodies targeting interleukin (IL)-12, IL-23, and IL-17 pathways are now available.
• The impact of these novel IL-blocking therapies on Mycobacterium tuberculosis (Mtb) reactivation risk is not yet clear.

Purpose of the Study:

• To review the immunologic response to Mtb.
• To discuss current data on the risk of latent TB reactivation or active TB infection associated with IL-blocking monoclonal antibodies.

Main Methods:

• Literature review of immunologic responses to Mtb.
• Analysis of available data on IL-blocking therapies and TB reactivation.

Main Results:

• Established role of TNF in Mtb containment and increased TB risk with TNF blockers.
• Limited data currently available on the Mtb reactivation risk associated with IL-blocking agents.

Conclusions:

• The risk of Mtb reactivation with IL-blocking monoclonal antibodies requires further investigation.
• Clinical guidelines may need to be updated to address screening for Mtb in patients receiving IL-blocking therapies.