title: Guidance for the management of patients with latent tuberculosis infection requiring biologic therapy in rheumatology and dermatology clinical practice.
abstract: Since the introduction of biologics for the treatment of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), and psoriasis (Pso) an increased risk of tuberculosis (TB) reactivation in patients with latent tuberculosis infection (LTBI) has been recorded for anti-TNF agents, while a low or absent risk is associated with the non-anti-TNF targeted biologics. To reduce this risk several recommendation sets have been published over time, but in most of them the host-related risk, and the predisposing role to TB reactivation exerted by corticosteroids and by the traditional disease-modifying anti-rheumatic drugs has not been adequately addressed. Moreover, the management of the underlying disease, and the timing of biologic restarting in patients with TB occurrence have been rarely indicated. A multidisciplinary expert panel, the Italian multidisciplinary task force for screening of tuberculosis before and during biologic therapy (SAFEBIO), was constituted, and through a review of the literature, an evidence-based guidance for LTBI detection, identification of the individualized level of risk of TB reactivation, and practical management of patients with TB occurrence was formulated. The literature review confirmed a higher TB risk associated with monoclonal anti-TNF agents, a low risk for soluble receptor etanercept, and a low or absent risk for non-anti-TNF targeted biologics. Considering the TB reactivation risk associated with host demographic and clinical features, and previous or current non-biologic therapies, a low, intermediate, or high TB reactivation risk in the single patient was identified, thus driving the safest biologic choice. Moreover, based on the underlying disease activity measurement and the different TB risk associated with non-biologic and biologic therapies, practical indications for the treatment of RA, PsA, AS, and Pso in patients with TB occurrence, as well as the safest timing of biologic restarting, were provided.
authors.affiliation: Division of Rheumatology, Hospital of Prato, Italy. Electronic address: fbrzcantini@gmail.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cantini
authors.affiliation: Division of Rheumatology, Hospital of Prato, Italy.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Nannini
authors.affiliation: Division of Rheumatology, Hospital of Prato, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Niccoli
authors.affiliation: Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Italy.
authors.forename: Florenzo
authors.initials: F
authors.lastname: Iannone
authors.affiliation: Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Delogu
authors.affiliation: Department of Health Science (DISSAL), Section of Radiology, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Garlaschi
authors.affiliation: Respiratory and Rheumatology Research Units, Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanduzzi
authors.affiliation: Immunoallergology Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Matucci
authors.affiliation: Division of Clinical, Preventive and Oncology Dermatology, Department of Surgery and Translational Medicine, Florence University, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Prignano
authors.affiliation: Department for Prevention, Local Health, Taranto, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Conversano
authors.affiliation: Translational Research Unit, Department of Epidemiology and Preclinical Research, "L. Spallanzani" National Institute for Infectious Diseases (INMI), IRCCS, Italy.
authors.forename: Delia
authors.initials: D
authors.lastname: Goletti
mesh_terms: D001172:Arthritis, Rheumatoid / Q000150:complications; D001691:Biological Therapy; D006801:Humans; D055985:Latent Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D012871:Skin Diseases / Q000150:complications*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D014409:Tumor Necrosis Factor-alpha
keywords: Ankylosing spondylitis; Biologics; Psoriasis; Psoriatic arthritis; Rheumatoid arthritis; Tuberculosis