TNF inhibitors: prescribers reminded of tuberculosis risk

on the 17 April 2014

The MHRA has issued a reminder to prescribers regarding the increased risk of tuberculosis (TB), or reactivation of latent TB, during treatment with tumour necrosis factor (TNF) inhibitors.

Inhibitors of tumour necrosis factor (pictured) are licensed for various autoimmune musculoskeletal disorders, psoriasis and inflammatory bowel disease | SCIENCE PHOTO LIBRARY

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 contact 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.

Further information: MHRA Drug Safety Update 2014

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