How should we manage latent tuberculosis infection in patients receiving anti-tnf-α drugs: Literature review

Context: 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. Evidence Acquisition: 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 March²0¹⁵. Two reviewers extracted and summarized the data and suggested protocols for the diagnosis and management of LTBI in patients receiving TNF-α inhibitors. Results: 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. Conclusions: 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.