TNF inhibitors are contraindicated in patients with active TB or other severe infections and should not be used in patients with latent TB until appropriate anti-TB treatment has been initiated.
The MHRA advice reminds prescribers to:
- Screen patients for active and latent TB before starting TNF inhibitor therapy and to record the results on the patient’s alert card (supplied by the drug's manufacturer). Assessment should include a detailed medical history of any possible previous with TB and any history of immunosuppressive therapy, a tuberculin skin test,* and a chest radiograph.
- Start anti-TB treatment before TNF inhibitor therapy if latent TB diagnosed and consider anti-TB treatment if latent TB is suspected. A specialist in TB treatment should also be consulted.
- Monitor patients closely for infectious diseases including TB before, during and after treatment.
- Provide patients with a patient alert card and advise them to seek medical advice if symptoms of TB (eg, persistent cough, weight loss, low-grade fever) develop during or after TNF inhibitor therapy.
*Prescribers should be aware of the risk of false-negative tuberculin skin test results, especially in severely ill or immunocompromised patients.