Biologics and Tuberculosis Preventive Therapy.

Biologics have revolutionized the management of systemic inflammatory disorders in the last few decades. The most common side effect associated with these agents is increased susceptibility to infection. Increased risk of tuberculosis (TB) reactivation in patients with latent tuberculosis infection (LTBI) has been recorded for anti-tumor necrosis factor (TNF) agents and, to a lesser extent, for the nonanti-TNFα targeted biologics. Use of both biologic agents and Janus kinase (JAK) inhibitors is associated with increased risk of TB disease. LTBI screening prior to initiation of a biologic agent or JAK inhibitor and treatment of positive cases significantly reduces the incidence of TB disease, though it does not eliminate it. Several recommendations and guidelines have been published, but none of them apply globally due to variable socioeconomic conditions and endemicity of TB in different countries. At present, we have a national guideline in India from the National Tuberculosis Elimination Programme (NTEP) in the form of Guidelines for Programmatic Management of Tuberculosis Preventive Therapy in India (PMTPT), which mandates TB screening and treatment for patients on immunosuppressive therapy and anti-TNF treatment. However, PMTPT is essentially a general recommendation. Clinicians need to be abreast of the integration of this approach with the variable risks of TB reactivation associated with different biologics in clinical practice.