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Hello

My rheumy wants to put me under Cosentyx. He prescribed a test to check for presence of tuberculosis infection as well as Hepatitis C. The lung X ray showed calcifications in my lungs. For the doctor it is a sure sign that I had tuberculosis a long time ago, likely as a child. So he wrote me as too high risk for Cosentyx. My parents are adamant I never had tuberculosis. Had anyone gone through the same experience? I have a hard time believing I got such a strong disease without knowing it.

From your post, it seems you had a chest x-ray to look for evidence of TB and the x-ray showed something. Did you have the skin test also? The hospital I work at tests employees who have direct patient access with the skin test but doesn't allow it to be used for patients of local physicians. Local doctors have begun ordering a serum TB test. I work in the lab and don't have direct patient access, but started biologics before the hospital stopped testing those of us in the lab (other than phlebotomists). Rheumy has to order the TB GOLD test for patients starting on biologics, which is sent off to QUEST LABS. I attached a link for you to read more about it. Hope you get it figured out soon. Seems odd to have had TB as a child without your parents knowing about it. Were you in an area that had problems with TB?

LabTestsOnline serum TB test


And here is a link for QUEST's info.

Here is the QUEST LAB info on the test.

Hi

Sorry for the late answer, I was quite busy.
I did not have a skin test. Thanks for the link, note that I am in Germany so the procedure is different.
Well apparently based on some research from my mother it is common to have TB as a child without knowing. The area I lived in was not particularly affected with problems AFAIK

Ok so I saw my Rheumy today. To my surprise he wants to put me under Cosentyx despite the internist doctor not to do so. He claimed that IL17 inhibitor like Cosentyx does not reactivate TB, only anti alpha TNF do. Is there any studies that proves this ?
He is saying the FDA or European drugs regulatory bodies do not differentiate as all are biological therapy, they requires the same risk assessment.
So he wants to put me under an antibiotic called Isoniazid for 4 weeks before starting Cosentyx.
I asked for two weeks time to think about this before accepting. I would really appreciate any pointers.

There are a few ways to proceed. I'm going to assume you had a BCG done as a child, which is the case in many European countries. If that's the case, then one way is to order a test called "Quantiferon Gold," which is a good test of whether you have active TB.

Starting on INH therapy is also reasonable. Once you are on a bactericidal antibiotic that will kill TB with good clinical response, there is no reason to withhold treatment.

While IL17 inhibitors do not reactivate TB like TNF inhibitors do, it's still pretty irresponsible to put a patient with any kind of known infection on an immunosuppressant until you have the infection treated with appropriate antimicrobial therapy and with good clinical response (if applicable, which in your case it isn't because you have no signs or symptoms other than the X-ray).

I maybe should have updated this thread: I had the Quantiferon Gold test done and it came back negative. Another doctor looked at my X-Rays and has a different conclusion. That and the fact that the test is negative means I did not had latent TB, so I am all clear for Cosentyx.