Minimizing missed latent tuberculosis infection under adalimumab: real-world data from a BCG-vaccinated cohort

Background Tumor necrosis factor-alpha (TNF-α) inhibitors, particularly adalimumab (ADA), are widely used for ocular inflammatory diseases but may increase the risk of tuberculosis reactivation. Data on latent tuberculosis infection (LTBI) screening and outcomes are limited. This study aimed to describe LTBI screening outcomes in ADA-treated uveitis and identify patterns of missed cases. Methods A total of 188 patients evaluated for ADA eligibility between December 2021 and April 2025 were retrospectively analyzed. LTBI screening included medical history, tuberculin skin test (TST), interferon-gamma release assay (IGRA), or both. Isoniazid prophylaxis was given when indicated, and tuberculosis occurrence during ADA was assessed. Results Among 188 patients (mean age 40.3 ± 14.2 years), Behçet's uveitis (39.7%) and sarcoidosis (23.9%) were the most common. TST alone was used in 60.2%, IGRA in 13.4%, and both in 26.3% among those with baseline testing. TST and IGRA results were significantly associated (p = 0.001). INH prophylaxis rates varied by screening method (p = 0.003). Tuberculosis occurred in 1.6% (n = 3), including two despite prophylaxis. Conclusion LTBI screening and prophylaxis reduce but do not eliminate TB risk under ADA. Combined TST/IGRA and periodic re-evaluation may reduce missed cases in BCG-vaccinated populations.