Prevention of tuberculosis in patients taking tumor necrosis factor-alpha blockers.
Treatment with tumor necrosis factor-alpha (TNF-alpha) inhibitors increases the risk of tuberculosis (TB) due to reactivation of latent Mycobacterium tuberculosis infection (LTBI). Screening for LTBI is based mainly on the tuberculin skin test (TST), which has several limitations in any patient who is immunosuppressed due to drugs or autoimmune disease. T cell interferon-gamma release assays (IGRA) have been shown to be more specific than TST in immunocompetent patients and potentially represent a new approach for the management of patients taking TNF-alpha blockers. Even if there is no evidence-based literature of IGRA superiority versus TST in this specific clinical setting, some studies suggest blood assays may be helpful in clinical management of these patients, in addition to currently recommended clinical screening for risk factors for LTBI.
Bellofiore
Barbara
B
Division of Respiratory Disease, University of Naples Federico II, 80131 Naples, Italy.
Matarese
Alessandro
A
Balato
Nicola
N
Gaudiello
Francesca
F
Scarpa
Raffaele
R
Atteno
Mariangela
M
Bocchino
Marialuisa
M
Sanduzzi
Alessandro
A
D000068879:Adalimumab; D019072:Antibiotic Prophylaxis; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents / Q000627:therapeutic use*; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab; D007371:Interferon-gamma / Q000032:analysis; D018124:Receptors, Tumor Necrosis Factor; D014376:Tuberculosis / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000009:adverse effects*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000995:Antitubercular Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept