In India, latent tuberculosis is common enough that a screen before any biologic or JAK inhibitor is essential, not optional. TNF inhibitors carry the highest risk of reactivation, but none of the newer classes is exempt.
Use an interferon-gamma release assay or tuberculin skin test plus a chest X-ray, and ask about contacts and previous treatment. Start preventive therapy before the biologic when latent infection is found, and re-screen if there is new exposure.
- Do an IGRA or tuberculin skin test and a chest X-ray before starting any biologic or JAK inhibitor.
- Ask about household contacts and previous TB treatment.
- Treat latent infection before starting, in line with national guidance.
- Re-screen after new exposure or unexplained fever, weight loss or cough on treatment.
Why it matters
Register data from low-incidence countries understate the TB risk faced by patients treated in India.
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