Surreal illustration of the intersection between the immune system and tuberculosis risk.

Biologics and TB: Are You at Risk?

Soraya Malik in Health & Wellness July 2025 • 4 min read.

"A new study reveals the tuberculosis risks associated with biologic therapies for immune-mediated diseases, particularly in TB-endemic regions. Find out if you're at risk and what precautions to take."

Biologic therapies have transformed the treatment of immune-mediated diseases like rheumatoid arthritis, IBD, and psoriasis, offering targeted relief where traditional medications fall short. However, these powerful drugs, which suppress parts of the immune system, come with their own set of risks.

One significant concern is the heightened susceptibility to infections, including tuberculosis (TB). While this risk is known, a new study sheds light on the specific extent of this risk in TB-endemic regions like Hong Kong, offering valuable insights for patients and healthcare providers.

This article unpacks the findings of this population-based study, explaining the increased TB risk associated with biologic therapies, particularly infliximab, and providing a clear understanding of what these findings mean for individuals with immune-mediated diseases.

Understanding the TB Risk with Biologics

Surreal illustration of the intersection between the immune system and tuberculosis risk.

The study, conducted in Hong Kong, analyzed data from 2,485 patients with immune-mediated diseases receiving biologic therapies. The results revealed a stark reality: patients on biologics had a more than 10-fold increased risk of developing active TB compared to the general population.

The risk varied depending on the specific biologic drug used. Infliximab, a TNF inhibitor, was associated with the highest risk, increasing TB risk nearly 26 times compared to the general population. Other TNF inhibitors also increased the risk, though not as drastically as infliximab.

Overall Increased Risk: Patients on biologics face a significantly higher risk of TB.
Infliximab Alert: Infliximab carries the highest TB risk among the biologics studied.
TNF Inhibitors: TNF inhibitors, in general, elevate TB risk compared to non-TNF biologics.

Specifically, the research indicated that infliximab posed a greater risk than etanercept and adalimumab, two other commonly prescribed biologics. This stratification of risk among different biologic therapies provides crucial information for doctors when making treatment decisions.

What This Means For You

If you are currently taking or are considering starting biologic therapy for an immune-mediated disease, these findings underscore the importance of discussing TB risk with your doctor. Screening for latent TB infection is crucial before starting a biologic, and ongoing monitoring is also recommended.

While the increased risk is concerning, it's important to remember that biologics can significantly improve the quality of life for many individuals with chronic conditions. Understanding the risk allows for informed decision-making and proactive management.

Ultimately, the goal is to strike a balance between the benefits of biologic therapy and the potential risks, ensuring the best possible outcome for each patient. Staying informed, maintaining open communication with your healthcare provider, and adhering to screening and monitoring guidelines are key steps in this process.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/rheumatology/key364, Alternate LINK

Title: Risk Of Tuberculosis In Patients With Immune-Mediated Diseases On Biological Therapies: A Population-Based Study In A Tuberculosis Endemic Region

Subject: Pharmacology (medical)

Journal: Rheumatology

Publisher: Oxford University Press (OUP)

Authors: Xing Wang, Sunny H Wong, Xian-Song Wang, Whitney Tang, Chang-Qin Liu, Gani Niamul, Bin Wu, Lai-Shan Tam, Justin C Y Wu, Francis K L Chan, Joseph J Y Sung, Siew C Ng

Published: 2018-12-14

Everything You Need To Know

What are biologic therapies?

Biologic therapies are treatments for immune-mediated diseases like rheumatoid arthritis, IBD, and psoriasis. These therapies offer targeted relief by suppressing parts of the immune system. This article highlights that biologics, while effective, increase the risk of tuberculosis (TB). The risk is particularly pronounced in regions where TB is common.

What is the overall risk of TB for patients on biologics?

The study shows that patients on biologics have a significantly higher risk of developing active TB. In the study conducted in Hong Kong, the risk was over 10 times greater compared to the general population. This increased risk is a critical consideration, especially in TB-endemic regions, as it means individuals undergoing biologic therapy are much more susceptible to TB infection.

Which specific biologic carries the highest TB risk?

Infliximab, a TNF inhibitor, was identified as carrying the highest risk among the biologics studied. The study found that infliximab increases the TB risk nearly 26 times compared to the general population. Other TNF inhibitors also showed an elevated risk, though not as high as with Infliximab. This distinction is crucial because it helps doctors choose the safest and most effective treatment.

What should I do if I am taking or considering biologics?

The implications of these findings emphasize the importance of patient screening and ongoing monitoring. If you are taking, or considering biologics for an immune-mediated disease, discussing your TB risk with your doctor is essential. Screening for latent TB infection before starting biologic therapy is crucial, and ongoing monitoring is also recommended to detect any potential TB infections early.

Why do biologics increase the risk of TB?

Immune-mediated diseases like rheumatoid arthritis, IBD, and psoriasis are treated with biologic therapies. These therapies, while effective, affect the immune system. Tuberculosis (TB) is a bacterial infection that can become active when the immune system is suppressed. The use of biologics, specifically Infliximab and other TNF inhibitors, increases the risk of TB because they suppress the immune response, making patients more vulnerable to TB infection.