Risk of TB during biologic therapy of rheumatic diseases

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.