Tuberculosis and TNF-α inhibitors in children: how to manage a fine balance

Tuberculosis and TNF-α inhibitors in children: how to manage a fine balance


  • Sara Parigi Post-graduate School of Paediatrics, Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy
  • Amelia Licari Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
  • Sara Manti UOC Broncopneumologia Pediatrica e Fibrosi Cistica, AOUP “Vittorio-Emanuele”, San Marco Hospital, Università di Catania, Catania, Italy
  • Gian Luigi Marseglia Pediatric Clinic Department of Pediatrics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
  • Maria Angela Tosca Allergy Center, Department of Pediatrics, Istituto G. Gaslini, Genoa, Italy
  • Michele Miraglia del Giudice Department of Woman, Child and of General and Specialized Surgery. University of Campania "Luigi Vanvitelli" Naples, Italy
  • Carlo Caffarelli Clinica Pediatrica, Dipartimento di Medicina e Chirurgia, Università di Parma, Italy
  • Mauro Calvani UOC di Pediatria. Azienda Ospedaliera S. Camillo Forlanini, Roma, Italy
  • Alberto Martelli Department of Pediatrics, G.Salvini Hospital, Garbagnate Milanese, Milan – Italy
  • Fabio Cardinale Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria Consorziale-Policlinico, Ospedale Pediatrico Giovanni XXIII, Bari, Italy.
  • Claudio Cravidi Agenzia Tutela della Salute, ATS (National Healthcare System), Pavia, Italy.
  • Marzia Duse Department of Pediatrics, Sapienza University, Rome, Italy
  • Elena Chiappini Division of Paediatric Infectious Disease, Anna Meyer Children's University Hospital, Department of Health Sciences, University of Florence, Florence, Italy.


Tuberculosis, latent tuberculosis, TNF inhibitors, children, immune.mediated diseases


Since the introduction of biologic response modifiers (BRMs) in the management of children affected by the immune-mediated inflammatory disease, these patients substantially improved their quality of life. BRMs are generally well tolerated and effective in most children and adolescents refractory to conventional immunosuppressive therapy. On the other hand, patients receiving BRMs, especially TNF-α inhibitors, display an increased risk of primary infections or reactivations, i.e. due to Mycobacterium tuberculosis. M. tuberculosis can cause severe disease with consequent short- and long-term morbidity in children on anti-TNF-α treatment. The present paper analyses the increased risk of reactivation of latent tuberculosis infection (LTBI) or de novo TB infection in children treated with TNF-α inhibitors, with the purpose to provide recommendations for screening strategies and safety monitoring of paediatric patients. Special attention is also given to the currently available TB screening tools (IGRAs and TST) and their utility in the diagnosis of LTBI before starting the biologic therapy and during the treatment. Finally, the paper analyses the suggested TB-preventing therapies to adopt in these children and the correct timing to overlap anti-TB and anti-TNF-a treatment.


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How to Cite

Parigi S, Licari A, Manti S, Marseglia GL, Tosca MA, Miraglia del Giudice M, et al. Tuberculosis and TNF-α inhibitors in children: how to manage a fine balance. Acta Biomed [Internet]. 2020 Sep. 15 [cited 2024 Jul. 23];91(11-S):e2020009. Available from: