The Risk of Tuberculosis and TNF-alpha Inhibitors

The clinical use of TNF-alpha inhibitors have been increasing in the treatment of autoimmune disorders. The most common anti-TNF-alpha agents on clinical use are ethanercept, infliximab and adalimumab. TNF-alpha is an important mediator in the pathogenesis of tuberculosis, therefore the use of TNFAI increases the risk of tuberculosis. Patients who are on anti-TNF alpha treatment should be carefully evaluated for tuberculosis risk before and during therapy. The recommended screening tools are detailed history, physical examination, tuberculin skin test and/or interferon gamma (IFN-gamma) release assay and chest X-Ray every six months