Biological agents and tuberculosis: Risk estimates and screening strategies

[Extract] The introduction of biological agents has revolutionized the management of rheumatic diseases. However, the immunomodulatory effect of these drugs is associated with an increased risk of infection, especially an increased risk of tuberculosis (TB) reactivation – a fact of which the medical community has been well aware ever since a study on TB case reports after infliximab therapy was published in 2001. The recognition of an increased risk of TB reactivation in patients on tumor necrosis factor‐alpha (TNF‐α) inhibitor treatment has led to the publication of numerous guidelines on screening and treatment for latent TB infection (LTBI) in these patients, but many uncertainties remain.