Tuberculosis testing

Biologics and immunotherapy

Treatment for rheumatologic, inflammatory diseases and other conditions puts your patients at risk for tuberculosis.

Patients on biotherapy are at risk for TB

Treatments using disease-modifying antirheumatic drugs (DMARDs), immunosuppressants and glucocorticoids have revolutionized the treatment of autoimmune diseases such as rheumatoid arthritis, Crohn's disease and psoriasis.

However, patients undergoing immunotherapy face an increased risk for tuberculosis. The immune system helps contain TB infection and prevent progression to active TB disease. One of the most common classes of DMARDs, TNF-α inhibitors, puts patients at a 9-fold increased risk of developing active TB (1).

To limit the risk of TB progression, global recommendations now include a screening test for TB infection for most patients receiving biotherapy (2–7).


Who should be tested?

What therapeutics can increase TB risk?
What therapeutics can increase TB risk?

TB testing is recommended prior to most immunotherapies used for rheumatologic and inflammatory diseases (2–7), as well as those used in oncology/hematology settings (8, 9). Global experts recommend testing prior to:

  • bDMARDs (TNF inhibitors)
  • tsDMARDs (JAK inhibitors)
  • csDMARDs (methotrexate)
  • Interleukin inhibitors
  • Immunosuppressants
  • Glucocorticoids
    • Immune checkpoint inhibitors
    • Monoclonal antibodies
Which of your patients requires TB testing?

Global guidelines and pharmaceutical labeling requirements reinforce that TB testing is critical when evaluating your patient’s treatment options. These treatments extend beyond use in rheumatology, impacting gastroenterology, dermatology and cancer treatment.

In addition to identifying an immediate risk of TB reactivation during primary treatment, TB testing prior to immunotherapy provides you with flexibility as your patient ages and progresses to new medications.

Publications

Help protect at-risk patients: The clinical value of QuantiFERON-TB Gold Plus in rheumatology

Across both endemic and low-prevalence settings, these studies highlight the importance of routine screening for TB infection (TBI) in patients receiving or preparing to receive immunosuppressive therapies. Explore these three key publications that highlight clinical performance, real-world use and decision-making across immunocompromised patients.

QuantiFERON reliably identifies
TB infection in people treated
with DMARDs or small molecules 		QuantiFERON identifies TB
infection in RA patients missed
by patient history and chest X-ray 		Risk-based IGRA testing during
DMARD therapy may sufficiently
manage conversion risk
Key findings:
  • The prevalence of TBI was
    10.1% among the patient
    s evaluated, mirroring endemic
    prevalence in Mexico.
  • TBI screening should
    be applied to all patients
    starting biologic therapy.
Clinical perspective:
  • Including QFT-Plus as part
    of routine screening protocols
    helps identify patients who may
    require preventive management
    before initiation of advanced
    immunosuppressive therapies.

Corona, LFV et al. Reumatología Clínica,
Volume 22, Issue 4, April 2026, Pages 502097.

Key findings:
  • TBI positivity was 14.2% among
    rheumatology patients
    in a low-prevalence country (Germany).
  • Among 3 screening methods
    (QFT-Plus, patient history and chest X-rays),
    QFT-Plus was the sole positive
    indicator in 46/99 TBI-positive
    patients.
Clinical perspective:
  • TBI screening is important even
    in low-prevalence countries.
  • Including QFT-Plus in addition
    to chest X-ray and medical
    history is critical to accurately
    identify TBI status.

Feuchtenberger M, Kovacs MS, Nigg A
and Schafer S. Clin Rheumatol.
2025 Feb 25;44(4):1851–1859.

Key findings:
  • In a non-endemic setting, only 4/339 DMARD
    patients converted from negative
    to positive QFT-Plus result during
    5 years of serial testing.
  • A targeted, risk-based TBI
    screening strategy may be more clinically
    efficient than routine annual
    testing in low-risk DMARD-treated patients.
Clinical perspective:
  • QFT-Plus can support informed
    screening decisions that focus
    testing on patients with relevant
    TB exposure risks, helping
    to maintain vigilance while
    reducing unnecessary repeat
    testing.

Palacios CF, et al. PLoS One.
2024 Jul 3;19(7):e0306337.

Testing with QuantiFERON

In addition to screening for TB at the onset of immunotherapy, retesting every 1–2 years for patients who have a new or recurring risk factor should be considered. Risk factors include living in or extended travel to an endemic country, TB exposure, or employment in a healthcare or congregate setting. Risk factors such as smoking, substance use disorders, diabetes, etc. should also be considered.

What test should you use for TB testing?

The WHO states that TB blood tests (IGRA) can be used interchangeably with the tuberculin skin test.

The latest EULAR guidelines further state that IGRAs are the preferred test for patients with autoimmune disorders for their performance and ease of use. TB blood tests are:

  • Accurate
  • Single visit
  • Unaffected by the BCG vaccine

Featured resources

Choose modern testing for your at-risk patients
Reduce the risk of TB with QuantiFERON-TB Gold Plus
Find out more
References:
  1. Lobue, P. and Menzies, D. Treatment of latent tuberculosis infection: An update. Respirology. 2010;15: 603-622.
  2. Lewinsohn DM, et al. Official ATS/IDSA/CDC clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017;111-115.
  3. US CDC. Updated guidelines for using Interferon Gamma Release Assays to detect Mycobacterium tuberculosis infection — United States, 2010. MMWR 2010; 59, RR-5.
  4. World Health Organization. WHO consolidated guidelines on tuberculosis: tuberculosis preventive treatment. 2020.
  5. Fragoulis, GE, et al. 2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2022;0:1–12.
  6. Diel, R, et al. Joint Statement (DZK, DGRh, DDG) on the Tuberculosis Risk with Treatment Using Novel Non-TNF-Alpha Biologicals. Pneumologie. 2021;75: 293–303
  7. NSTC/NTCA. Testing and treatment of latent tuberculosis infection in the United States: clinical recommendations. February 2021.
  8. Anastasopoulou, A, et al. Reactivation of tuberculosis in cancer patients following administration of immune checkpoint inhibitors: current evidence and clinical practice recommendations. J Immunotherapy Cancer 2019;7:239.
  9. Lin, C, et al. Tuberculosis infection following immune checkpoint inhibitor treatment for advanced cancer: a case report and literature review. Front. Immunol. 2023;14:1162190.