Before starting a biologic, a JAK inhibitor or another systemic immunosuppressant, a short pre-treatment screen prevents the reactivations that are far harder to manage once treatment is under way. In India, with its high tuberculosis burden, this step carries more weight than the trial populations behind these drugs suggest.
Check for latent tuberculosis with a tuberculin skin test or interferon-gamma release assay plus a chest radiograph, and test for hepatitis B and C; screen HIV status where risk warrants. Treat latent tuberculosis before or alongside starting therapy as local guidance directs.
Record baseline bloods and bring the patient's vaccinations up to date, giving live vaccines before immunosuppression where needed. A few minutes of screening at the outset avoids a serious infection later.
- Screen for latent tuberculosis with a tuberculin skin test or interferon-gamma release assay and a chest radiograph.
- Test for hepatitis B and C, and HIV where risk warrants, before starting therapy.
- Treat latent tuberculosis before or alongside therapy as local guidance directs.
- Update vaccinations first, giving live vaccines before immunosuppression where needed.
Why it matters
Reactivation of tuberculosis or hepatitis on immunosuppression is far harder to manage than preventing it with a short pre-treatment screen.
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