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(+) PPD Test and Biologics

Posted by: Mary Maritch on March 15, 2009 at 4:18PM EST

Does anyone have a history of a (+) TB test before taking biologics? Did you take medicine for the latent TB before or after the biologic was administered? Any info on this matter will be greatly appreciated.

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(3) Comments

Posted by: SheriB on March 15, 2009 7:37PM EST

I tested (+) on my TB test and i had to take 300 mg of Isoniazid for 3 months before i could start Humira.

Posted by: o on March 18, 2009 11:57AM EST

Did you only take 3 months of Isoniazid?. I had a positive PPD over 10 years ago. And was treated with Isoniazid for 6 months at that time 6 months was the recommended time. I believe now is 9 months. My dr. didn't think I needed the additional 3 months.

Posted by: ray on March 30, 2009 5:11PM EST

during the screening process for biologic therapies, such as humira, the doctor or nurse should attempt to rule out latent tb.

this usually involves asking about any personal or family history of tb, whether or not the patient has a bcg scar from the vaccination against tb, and a recent chest x-ray (within the last 6 months), specifically looking for tb in the lungs.

if anything suspicious is found during this process, in some facilities, quantiferon gold blood tests are currently being used to confirm the presence or otherwise of latent tb. other tests that might be used include mantoux or heaf. i am not aware of anyone in the uk using heaf tests anymore.

if there is a strong suspicion of latent tb, then the clinician (usually a chest physician) must assess the risk of toxicity (drug induced hepatitis) from the tb chemotherapy used (such as isoniazid) against the risk of reactivation of tb. there is a an algorithm in the guidelines published by the british thoracic society. here is the link

http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Anti%20TNF%20Treatment/Guidelines/antitnf_treatment.pdf

as far as i am aware, even after tb chemotherapy, there is still a small risk. the overall risk is reduced by 65%.

as for the duration of treatment, if isoniazid is used on it's own, the course might be for 6 months. if rifampicin is added then a 3 month course is usually given. this will obviously be a chest physician's decision who will have taken everything into consideration.

i have known some patients to commence tb chemotherapy and start anti-tnf after the first month of treatment but they do continue to the end of the course.

i hope this helps you.
Ray