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Brazilian recommendations are unclear about TBI screening and its preventive treatment (TPT) in persons with IMID.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>To provide a comprehensive and evidence-based guideline for managing TBI in persons with IMID in Brazil.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This task force was constituded by 42 specialists with interest in IMID and TBD. A core leadership team (CLT) drafted fourteen clinical questions on the risk of tuberculosis and indications of TPT among persons with IMID who started, or are about to start immunosuppressive drugs. The CLT supervised the systematic reviews and formulated the recommendations. The experts voted using the Delphi Method.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Nine recommendations were established. More than 80% of panelists voted \u201cagree\u201d and \u201cstrongly agree\u201d with all statements. In brief, all persons with IMID starting or about to start immunosuppressive treatment should undergo tuberculin skin testing (TST) or interferon-gamma release assays (IGRAs), a chest imaging test and investigation of contact with active pulmonary or laryngeal TBD. TPT is mandatory for those with any positive result after excluding TBD. Exceptions include individuals with a history of TBD or a past positive TBI infection test. IGRA is preferred only in persons BCG-vaccinated in the past 2 years. Those with inconclusive IGRA results can have the test repeated once, and TPT should be offered if it remains indeterminate. TST or IGRA should be repeated yearly, for three years, when the previous test was negative, when starting or changing to a different class of immunosuppressive drug. Overall, the included studies had a low quality of evidence and high risk of bias.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>These guidelines are meant to improve the management of TBI in IMID. Health professionals must consider the epidemiological risk, host features, the social scenario, the characteristics of the disease, the access to health resources, and the development of an individualized plan for every patient.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s42358-025-00449-4","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T04:00:25Z","timestamp":1742443225000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Brazilian recommendations for the management of tuberculosis infection in immune-mediated inflammatory diseases"],"prefix":"10.1186","volume":"65","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6386-3776","authenticated-orcid":false,"given":"Viviane Angelina","family":"de Souza","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Luiza Mendes 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Several authors of these guidelines, including voting members, have interacted with the pharmaceutical industry including the manufacturers of some of the drugs mentioned in these recommendations. However, none of the authors received any support or fee directly or indirectly related to or influencing the development of these guidelines. AKGM received speaker fees and consulting from Abbvie, Johnson & Johnson. AMK received consuting fees from Abbvie, Lilly, UCB, Organon, and Janssen. CF received speaker fees from Takeda, Janssen, Abbvie, Amgen, Organon. ESP received speaker fees and consulting from Abbvie, Novartis, Lilly, Johnson & Johnson. JSC received speaker fees from GSK and Janssen. KLLLM received speaker fees and consulting from Novartis and Johnson & Johnson. LAC received speaker fees and consulting from Johnson & Johnson, Takeda, Abbvie. LDAV received speaker fees and consulting from Novartis, Johnson & Johnson. LMHM received speaker fees and consulting from Johnson & Johnson, Abbvie, Pfizer, Novartis, Amgen, Organon, Celltrion, UCB. MFBRG received speaker fees and consulting from Johnson & Johnson, Abbvie, Amgen, Lilly, UCB. MIBFL received speaker fees and consulting from Abbvie, Novartis, Takeda, Johnson & Johnson. MMP received consuting fees from Abbvie, Lilly and Janssen. RMX received Speaker fees, consulting, research funding from Abbvie, Pfizer, Amgen, Biogen, Novartis, Janssen, UCB. RR is\/has served as a scientific consultant, speaker, or clinical study investigator for AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Galderma, Janssen-Cilag, Eli-Lilly, Leo-Pharma, Novartis, Pfizer, Sanofi, and UCB. RSH received speaker fees and consulting from Abbvie, Novartis, Takeda, Johnson & Johnson. OAM received consulting fees from AstraZeneca and GSK; received payment or honoraria for lectures or presentations from AbbVie, Janssen, GSK, UCB and AstraZeneca; and participated in a data safety monitoring board or advisory board for GSK, CellTrion, Bristol, Novartis, Janssen, and AstraZeneca. VAS received speaker fees and consulting from Abbvie, Novartis, Lilly, Johnson & Johnson, GSK, Astrazeneca. VFA received speaker fees, consulting, clinical researches from Celltiron, Amgen, Janssen, Organon, Sandoz, Abbvie, Fresenius Kabi, Takeda, LG, Boehringer-Ingelheim, Bristol Myers-Squibb, GSK, AstraZeneca. Eduardo dos Santos Paiva is Co-EiC of Advances in Rheumatology. Ana Karla Guedes de Melo, Ana Cristina de Medeiros Ribeiro and Marcelo de Medeiros Pinheiro are Associate Editors of the journal Advances in Rheumatology; Ricardo Machado Xavier is a Consulting editor of the journal; Adriana Maria Kakehasi and Licia Maria Henrique da Mota are members of the editorial board of this journal. The peer-review of this paper was therefore overseen by an independent member of the editorial board while the submission was subject to the exact same review process as applied to any other manuscript. The authors not mentioned above declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"18"}}