Biologics and reactivation of latent tuberculosis
David J. Cohen, MD
September 25, 2008
Question:
What are your thoughts on biologics and their role in reactivation of latent tuberculosis? Is etanercept, because of its mechanism of action, less likely to reactivate tuberculosis? How often should you test for tuberculosis? Is there a test that is more accurate than chest x-ray or the purified protein derivative (PPD) test? Answer:
I believe that patients on any of the biologics or any of the systemic therapies should be evaluated for a history of tuberculosis or exposure to tuberculosis by a PPD test. A chest x-ray is warranted in some cases, as well, based on the patient’s history. I do not believe that one biologic or systemic therapy is safer than another. If a patient develops any symptoms of tuberculosis while on therapy (ie, cough, fever, night sweats, weight loss), treatment should be suspended and a work-up and full evaluation should be performed. In patients that show no change in health or symptoms that might represent tuberculosis, an annual PPD should serve as a satisfactory screening.
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