How Should We Manage Latent Tuberculosis Infection in Patients Receiving Anti-TNF-α Drugs: Literature Review

The introduction of new drugs that specifically antagonize tumor necrosis factor alpha (anti-TNF-α) has provided an effective treatment in a wide variety of autoimmune diseases. Nevertheless, the possibility of the reactivation of latent TB (Tuberculosis) infection (LTBI) among these patients is a considerable challenge. The aim of this paper is to evaluate LTBI diagnostic tools in patients who are candidates for anti-TNF-α therapy emphasizing how to manage these patients. A systematic web-based search was conducted in MEDLINE, Cochrane Library Database, and UpToDate® resources using the key words “anti-TNF-α” and “latent tuberculosis” up to March 2015. Two reviewers extracted and summarized the data and suggested protocols for the diagnosis and management of LTBI in patients receiving TNF-α inhibitors. There were somewhat different approaches proposed by various researchers regarding the subject. While no recommendation was found to be unique to include all patients in all situations, the data emphasize the importance of ruling out TB infection before deciding to start an anti-TNF-α drug. Special high-risk groups, including patients with LTBI, should be treated before receiving TNF-α inhibitors. The tuberculin skin test (TST) is a somewhat cost-effective test for the diagnosis of LTBI. However, its usefulness with respect to false results should be re-evaluated in this situation.