Risk stratification for tuberculosis reactivation in patients receiving biological and non-biological immunomodulators: A review of current literature.

Tuberculosis (TB) is a critical global health concern, with about one-quarter of the world's population having an immune response against Mycobacterium tuberculosis (MTB). These individuals are at risk of developing TB disease when their immune function is reduced. Given the increasing use of immunosuppressive agents, including biological and non-biological immunomodulators, the risk of TB infection (TBI) reactivation has significantly increased, highlighting the importance of screening and preventive treatment. The aim of this review is to summarize the current evidence on TB infection (TBI) reactivation mechanisms and risks associated with immunosuppressive agents, and to collate prescribing information from the Food and Drug Administration and the European Medicines Agency on TB screening. It covers ten major classes of immunosuppressants, including B- and T-cell depleting agents, interleukin antagonists, other cytokine antagonists, integrin antagonists, immune checkpoint inhibitors, kinase inhibitors, proteasome inhibitors, calcineurin inhibitors, glucocorticoids, and BCL-2 inhibitors.