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Letter in response to TB during TNF-α inhibitor therapy, despite screening
  1. K Manalan,
  2. A Singanayagam,
  3. M Wickremasinghe,
  4. O M Kon
  1. Correspondence to Professor Onn Min Kon, Chest and Allergy Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK; Onn.Kon{at}

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We read the case-based discussion published in Thorax by Hofland et al1 with great interest. The case studies reported by the authors raise a very important point about the necessity for continued monitoring of patients on tumour necrosis factor (TNF)-α antagonist therapy, even in the absence of evidence of latent TB infection (LTBI) at the onset of therapy and this is a point that is not discussed in the most recent British Thoracic society (BTS) guidance document on TB and anti-TNF α treatment.2

The two cases described in the article would be classified as ‘low risk’ and thus not offered chemoprophylaxis if managed according to current BTS recommendations. …

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