From the Guidelines
Yes, prednisone can cause a latent tuberculosis (TB) flare, especially when given at high doses (>15 mg/d) for prolonged periods of time 1.
Risk Factors for Reactivation
The risk of reactivation is increased in individuals with certain underlying conditions, such as:
- HIV infection
- Silicosis
- Diabetes mellitus
- Chronic renal failure
- Leukemia, lymphoma, or cancer of the head, neck, or lung
- Gastrectomy or jejunoileal bypass
- Weighing <90% of ideal body weight
- Cigarette smoking or substance abuse
Dose and Duration of Prednisone
The exact dose and duration of prednisone that increases the risk of TB reactivation are unknown, but it is likely that doses >15 mg/d for 2-4 weeks or more can suppress tuberculin reactivity and increase the risk of reactivation 1.
Clinical Considerations
It is essential to consider these risk factors and the dose and duration of prednisone when assessing the risk of latent TB reactivation in patients receiving this medication 1.
From the FDA Drug Label
If prednisone tablets is used to treat a condition in patients with latent tuberculosis or tuberculin reactivity, reactivation of tuberculosis may occur. Closely monitor such patients for reactivation. During prolonged prednisone tablets therapy, patients with latent tuberculosis or tuberculin reactivity should receive chemoprophylaxis
Yes, prednisone may cause a latent tuberculosis (TB) flare. Patients with latent tuberculosis or tuberculin reactivity should be closely monitored for reactivation and may require chemoprophylaxis during prolonged prednisone therapy 2.
From the Research
Latent Tuberculosis Flare and Prednisone
- The use of corticosteroids, such as prednisone, may promote the reactivation of latent tuberculosis infection 3.
- A study found that prednisolone treatment can severely suppress the performance of the QuantiFERON Gold In-Tube test and the tuberculin skin test, making it difficult to diagnose latent tuberculosis infection 4.
- However, another study found that there is no evidence to suggest that corticosteroids increase the risk of developing new tuberculosis or reactivating old tuberculosis 5.
- The risk of tuberculosis reactivation is higher in patients taking monoclonal anti-TNF agents, and corticosteroids may also play a role in this risk 6.
- A randomized, double-blind, placebo-controlled trial found that prophylactic prednisone can safely reduce the incidence of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (IRIS) in patients at high risk for the syndrome 7.
Key Findings
- Corticosteroids may reactivate latent tuberculosis infection 3, 4.
- The performance of diagnostic tests for latent tuberculosis infection may be suppressed by prednisolone treatment 4.
- The risk of tuberculosis reactivation is influenced by various factors, including the use of corticosteroids and biologic therapies 6.
- Prophylactic prednisone may be beneficial in reducing the incidence of paradoxical tuberculosis-associated IRIS in high-risk patients 7.