What is the actual risk of tuberculosis (TB) during biologic therapy of rheumatic diseases? Which class of drugs carries the highest risk of TB?
Gülen Hatemi, MD: Tumor necrosis factor (TNF)–alpha blockers are the major cause of TB among biologics. We know that the risk of TB under anti-TNFs depends a lot on the background TB risk in the population, because many of these patients have a reactivation of latent TB.
In Turkey we know that the TB risk under anti-TNF treatment is around 1% for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis patients. The risk is much higher for Behçet syndrome patients and is 4%. That is probably because TNF-alpha blockers are usually used together with immunosuppressives and high-dose glucocorticoids in Behçet syndrome patients.