Banerjee R.Ali R.A.R.SHU-CHEN WEIAdsul S.2021-06-152021-06-1520201976-2283https://www.scopus.com/inward/record.uri?eid=2-s2.0-85096255905&doi=10.5009%2fgnl19209&partnerID=40&md5=1213eb118b3e92428cb359ceca326ef2https://scholars.lib.ntu.edu.tw/handle/123456789/565640The advent of biologics and biologic therapy has transformed the management of inflammatory bowel disease (IBD) with enhanced early and adequate responses to treatment, fewer hospitalizations, a reduced need for surgery, and unprecedented outcomes including complete mucosal and histologic healing. However, an important issue with the use of anti-tumor necrosis factor (anti-TNF) agents in IBD is the increased risk of tuberculosis (TB). This is compounded by the diagnostic dilemma when differentiating between Crohn's disease and gastrointestinal TB, and the potentially serious consequences of initiating an incorrect treatment in the case of misdiagnosis. The interplay between IBD and TB is most relevant in Asia, where more than 60% of the 10.4 million new TB cases in 2016 were reported. A number of studies have reported an increased risk of TB with anti-TNF agents, including in patients who had tested negative for TB prior to treatment initiation. The limited evidence currently available regarding adhesion molecule antagonists such as vedolizumab suggests a comparatively lower risk of TB, thus making them a promising option for IBD management in TB-endemic regions. This comprehensive review examines the available literature on the risk of TB with the use of biologics in the TB-endemic regions of Asia, focusing on the diagnostic dilemma, the risk of reactivation, and the optimized management algorithms for latent and active disease. ? 2020 Editorial Office of Gut and Liver. All rights reserved.Asia; Biologic therapy; Colitis; Crohn disease; Tuberculosis; Ulcerative[SDGs]SDG3adalimumab; aminosalicylic acid; azathioprine; beclometasone dipropionate; biological product; corticosteroid; etanercept; golimumab; infliximab; mercaptopurine; mesalazine; methotrexate; natalizumab; tofacitinib; tumor necrosis factor inhibitor; ustekinumab; vedolizumab; biological product; infliximab; tumor necrosis factor; tumor necrosis factor inhibitor; corticosteroid; cyclosporine; immunomodulating agent; tumor necrosis factor; vedolizumab; algorithm; Article; Asia; Crohn disease; diagnostic error; evidence based medicine; histology; hospitalization; human; infection risk; inflammatory bowel disease; mass screening; tuberculosis; ulcerative colitis; inflammatory bowel disease; retrospective study; tuberculosis; biological therapy; controlled study; disease activity; disease severity; endemic disease; environmental exposure; gastrointestinal tuberculosis; heredity; inflammatory bowel disease; monotherapy; remission; Review; treatment response; Asia; Biological Products; Humans; Inflammatory Bowel Diseases; Infliximab; Retrospective Studies; Tuberculosis; Tumor Necrosis Factor Inhibitors; Tumor Necrosis Factor-alphajournal article10.5009/gnl19209331913102-s2.0-85096255905