| Latent TB dx without proper tx36,55,56* |
| Blood dyscrasia |
| Wegener's granulomatosis36,55 |
| Recent illness |
| Immunosuppressive disease |
| Ustekinumab only for drug-induced psoriasis, any history of malignancy (except for basal or squamous cell carcinoma skin cancer and cervical cancer in situ treated at least 5 years before the initiation of ustekinumab), and a history of active TB (latent, treated TB can receive treatment)7 |
| History of hepatitis, positive hepatitis B (which can be reactivated in chronic carriers, thus, the need for the vaccination), or active or untreated hepatitis C |
| Multiple sclerosis (except for ustekinumab) |
| Any demyelinating disorder7,36,55 |
↵* Patients diagnosed with tuberculosis (TB) who have received at least 2 months of treatment can receive a tumor necrosis factor (TNF)-α inhibitor with close supervision and a multidisciplinary approach. TNF-α modulates granuloma homeostasis and contains latent disease.57 In patients with a history of latent TB, indurations on PPD of >5 mm, even with history of BCG vaccination, is considered positive and exclusionary without proper treatment for TB.36,55 The risk of TB reactivation is lower with etanercept, a TNF-α, than with other monoclonal antibody inhibitors.58