Abstract
Anti-tumour necrosis factor (TNF) monoclonal antibodies or soluble TNF receptor have become an invaluable treatment against chronic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease and psoriasis. Individuals who are treated with TNF antagonists are at increased risk of reactivating latent infections, especially tuberculosis. Following TNF antagonist therapy, the relative risk for tuberculosis is increased up to 25 times, depending on the clinical setting and the TNF antagonist used. Interferon-γ release assays, or, as an alternative in individuals without a history of Bacille Calmette Guérin vaccination, tuberculin skin testing is recommended to screen all adult candidates for TNF antagonist for the presence of latent infection with M. tuberculosis. Moreover, paediatric practice suggests concomitant use of both the tuberculin skin test and an interferon-γ release assay, as there are insufficient data in children to recommend one test over the other. Consequent targeted preventive chemotherapy is highly recommended for all individuals with persistent M. tuberculosis specific immune responses undergoing TNF antagonist therapy as it significantly reduces the risk of progression to tuberculosis. This TBNET consensus statement summarizes current knowledge and expert opinions and provides evidence-based recommendations to reduce the tuberculosis risk among candidates for TNF antagonist therapy.
- ERS
