Tuberculosis Screening Before Rituximab Therapy

Recommended TB Screening Protocol Before Rituximab

The American College of Rheumatology recommends performing a thorough clinical risk assessment for TB exposure, including household contacts, prolonged stay or origin from endemic areas, before initiating rituximab therapy 2, 4
The European League Against Rheumatism recommends screening all patients for latent tuberculosis infection (LTBI) regardless of risk factors, as rituximab is a biologic disease-modifying antirheumatic drug (bDMARD) 2, 3

The Centers for Disease Control and Prevention (CDC) prefers interferon-gamma release assay (IGRA) over tuberculin skin test (TST) for diagnosing LTBI, especially in patients who have received BCG vaccination or are already on immunosuppressive therapy 1, 2, 5
The World Health Organization (WHO) recommends considering both TST and IGRA in cases of high suspicion for latent TB and/or in high-endemic countries 1
The American Thoracic Society recommends including chest X-ray as part of standard screening, even with negative IGRA or TST 1, 2

The Infectious Diseases Society of America recommends performing chest X-ray and clinical evaluation to rule out active TB in patients with positive IGRA or TST results 1, 6
The European Respiratory Society recommends referring patients to a specialist for appropriate anti-tubercular treatment if active or latent TB is diagnosed 5

The American Thoracic Society recommends treatment options for LTBI, including isoniazid for 9 months, rifampin for 4 months, or combination of rifampin/isoniazid for 3-4 months 1, 7
The Centers for Disease Control and Prevention (CDC) recommends once-weekly therapy of isoniazid plus rifapentine as an alternative treatment option for LTBI 1
The European League Against Rheumatism recommends initiating or resuming rituximab after at least 1 month of LTBI treatment 5, 8

The American College of Rheumatology recommends considering annual TB screening in patients who live, travel, or work in situations where TB exposure is likely 5
The Infectious Diseases Society of America recommends monitoring for clinical signs and symptoms of recurrent TB rather than repeating tests in patients who test positive at baseline 5, 8

The American Association for the Study of Liver Diseases recommends testing for hepatitis B virus (HBV) before starting rituximab, as it carries a risk of HBV reactivation 1, 9
The American Gastroenterological Association recommends considering screening for HIV and hepatitis C virus (HCV) as well 3, 4