Biologics and immunotherapy

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-a 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 (2-7).

What therapeutics can increase TB risk?

TB testing is recommended prior to most immunotherapies used for rheumatologic and inflammatory diseases (2–7), as well as those used in oncology/hematology settings (8, 9). Global experts recommend screening prior to:

• bDMARDs (TNF inhibitors)
• tsDMARDs (JAK inhibitors)
• csDMARDs (methotrexate)
• Interleukin inhibitors
• Immunosuppressants
• Glucocorticoids
• Immune checkpoint inhibitors
• Monoclonal antibodies

Which of your patients requires TB screening?

Global guidelines and pharmaceutical labeling requirements reinforce that TB testing is critical when evaluating your patient’s treatment options. These treatments extend beyond use in rheumatology, impacting gastroenterology, dermatology and cancer treatment.

In addition to identifying an immediate risk of TB reactivation during primary treatment, TB screening prior to immunotherapy provides you with flexibility as your patient ages and progresses to new medications.