Can You Get Tuberculosis From Humera? Understanding the Risks
No, you cannot directly get tuberculosis from Humera. However, Humera weakens the immune system, which increases the risk of reactivating latent tuberculosis.
Humera, a brand name for adalimumab, is a widely prescribed medication for autoimmune conditions like rheumatoid arthritis, Crohn’s disease, ulcerative colitis, psoriasis, and ankylosing spondylitis. It belongs to a class of drugs called TNF-alpha inhibitors. These medications work by blocking a protein called tumor necrosis factor-alpha (TNF-alpha), which is involved in inflammation. While Humera can significantly improve the quality of life for individuals suffering from autoimmune disorders, its immunosuppressive effects necessitate careful consideration, particularly regarding tuberculosis (TB).
The Science Behind TNF-alpha and Tuberculosis
TNF-alpha plays a crucial role in the body’s immune response to Mycobacterium tuberculosis, the bacterium that causes TB. Specifically, TNF-alpha helps to form and maintain granulomas, which are clusters of immune cells that wall off the TB bacteria. These granulomas prevent the bacteria from spreading and causing active TB disease.
When TNF-alpha is blocked by medications like Humera, the body’s ability to control latent TB infection is compromised. This means that someone who is already infected with TB (even without showing symptoms) is at a higher risk of the latent infection becoming active TB disease.
Humera and the Risk of Reactivation
The critical concern with Humera and TB is the reactivation of latent TB infection. Many people, particularly those from regions where TB is prevalent, may have been exposed to the bacteria and developed a latent infection. In this state, the bacteria are present in the body but are not causing any symptoms. The immune system keeps the infection under control.
Humera, by suppressing the immune system’s ability to form and maintain granulomas, can allow the latent TB bacteria to escape and multiply, leading to active TB disease. This is why screening for TB is mandatory before starting Humera treatment.
Pre-Treatment Screening is Essential
Before initiating Humera therapy, healthcare providers must screen patients for latent TB infection. This typically involves:
- Tuberculin Skin Test (TST) or Mantoux test: This test involves injecting a small amount of tuberculin under the skin and observing the reaction. A raised, hardened area indicates a possible TB infection.
- Interferon-Gamma Release Assay (IGRA): This blood test measures the immune system’s response to TB bacteria. Common IGRA tests include QuantiFERON-TB Gold and T-SPOT.TB.
- Chest X-ray: This imaging test can help identify signs of active TB disease in the lungs.
If the screening tests indicate a latent TB infection, the patient will need to undergo treatment for TB before starting Humera. This preventive treatment typically involves taking antibiotics for several months.
Monitoring During Humera Treatment
Even if the initial TB screening is negative, it’s important to remain vigilant during Humera treatment. Patients should be monitored for any signs or symptoms of TB, such as:
- Persistent cough (lasting longer than 2-3 weeks)
- Fever
- Night sweats
- Unexplained weight loss
- Fatigue
Any suspicion of TB requires immediate evaluation by a healthcare professional.
Minimizing the Risk
While Humera increases the risk of TB reactivation, the risk can be significantly minimized through proper screening and monitoring. Here’s a summary of key steps:
- Thorough TB screening before starting Humera.
- Treatment of latent TB infection before initiating Humera therapy.
- Regular monitoring for TB symptoms during treatment.
- Prompt evaluation of any suspected TB symptoms.
Factors Influencing the Risk
Several factors can influence the risk of TB reactivation in patients taking Humera:
- Geographic location: Individuals from regions with high TB prevalence are at higher risk.
- Age: Older adults may have a higher risk due to weakened immune systems.
- Underlying health conditions: Conditions that suppress the immune system can increase the risk.
- Concurrent medications: Other immunosuppressant medications can further increase the risk.
Here is a table comparing TST and IGRA tests:
| Feature | Tuberculin Skin Test (TST) | Interferon-Gamma Release Assay (IGRA) |
|---|---|---|
| Method | Skin injection | Blood test |
| Requires return visit | Yes | No |
| Affected by BCG vaccine | Yes | No |
| Time to results | 48-72 hours | Within 24 hours |
| Cost | Generally lower | Generally higher |
Weighing the Benefits and Risks
Humera offers significant benefits to individuals suffering from debilitating autoimmune conditions. However, like all medications, it also carries potential risks. The decision to start Humera should be made in consultation with a healthcare professional who can carefully weigh the benefits and risks, taking into account the individual patient’s medical history, geographic location, and other factors. Addressing concerns about “Can You Get Tuberculosis From Humera?” before starting treatment is crucial for informed decision-making.
Frequently Asked Questions (FAQs)
Can I get TB from someone taking Humera?
No, you cannot get active TB from someone taking Humera unless they have active TB disease and are spreading the bacteria through the air. Humera itself doesn’t cause TB; it only increases the risk of latent TB infection becoming active. If the person on Humera does not have active TB and is not coughing and spreading Mycobacterium tuberculosis, they cannot transmit the disease.
If I tested negative for TB before starting Humera, am I completely safe?
While a negative TB test before starting Humera reduces the risk significantly, it doesn’t guarantee complete safety. There’s a small chance of a false negative result or of acquiring a TB infection after testing but before starting Humera. Continuous monitoring for TB symptoms is essential.
What are the alternative medications to Humera with a lower risk of TB reactivation?
The risk of TB reactivation is associated with TNF-alpha inhibitors in general. If you’re concerned about this risk, discuss alternative treatment options with your doctor. There may be non-TNF-alpha inhibitor biologics or other types of medications that are suitable for your condition and carry a lower risk of TB reactivation.
How long does it take for TB to reactivate after starting Humera?
TB reactivation can occur anytime after starting Humera, but it’s most likely to happen within the first few months of treatment. However, reactivation can occur even years later. It is crucial to remain vigilant and report any suspicious symptoms to your doctor promptly.
What happens if I develop TB while taking Humera?
If you develop active TB while taking Humera, you will need to stop Humera immediately and begin treatment for TB. Treatment for TB typically involves taking a combination of antibiotics for several months. You may be able to resume Humera after the TB infection is fully treated, but this decision should be made in consultation with your doctor.
Can I prevent TB reactivation while on Humera?
The best way to prevent TB reactivation while on Humera is to undergo thorough TB screening before starting treatment and to treat any latent TB infection before initiating Humera therapy. Regular monitoring for TB symptoms and prompt evaluation of any suspected symptoms are also crucial.
Is it safe to travel to countries with high TB rates while on Humera?
Traveling to countries with high TB rates while on Humera increases your risk of exposure. Discuss your travel plans with your doctor. They may recommend additional precautions, such as getting a repeat TB test after returning from your trip.
Can I still get vaccinated against TB while on Humera?
The BCG vaccine, which is used to prevent TB, is a live vaccine and is generally not recommended for individuals who are taking immunosuppressant medications like Humera. Consult with your doctor regarding any vaccinations before starting Humera.
What if I refuse TB testing before starting Humera?
Refusing TB testing before starting Humera significantly increases the risk of TB reactivation. Your doctor may refuse to prescribe Humera if you refuse TB screening, as it would be considered medically irresponsible due to the potentially severe consequences.
Are there any specific lab tests I should ask for to monitor for TB while on Humera?
Aside from initial TB screening, routine lab tests specifically to monitor for TB while on Humera are not typically performed unless you develop symptoms suggestive of TB. If you develop symptoms, your doctor will order appropriate tests, such as a chest X-ray, sputum cultures, or blood tests.
Does Humira cause drug-resistant TB?
Humera does not directly cause drug-resistant TB. However, if someone with undiagnosed, active TB is started on Humera, and the TB is not treated properly (or if treatment is interrupted), this can contribute to the development of drug resistance in the TB bacteria.
Is there a difference in TB risk between Humera and other TNF-alpha inhibitors?
The risk of TB reactivation is a class effect of TNF-alpha inhibitors, including Humera, Enbrel, Remicade, Cimzia, and Simponi. The risk is generally considered to be similar across these medications, although some studies suggest variations. Your doctor can help you weigh the relative risks and benefits of each medication based on your specific circumstances.