# Adalimumab Therapy for Crohn's Disease and Axial Spondyloarthritis in Latent Tuberculosis: A bibliometric-systematic literature review

## TL;DR

This paper reviews the use of adalimumab for Crohn's disease and arthritis in areas with high tuberculosis risk, finding it effective but with some risk of TB reactivation.

## Contribution

The study provides a bibliometric and systematic review of adalimumab's use in TB-endemic regions with concurrent TB prophylaxis.

## Key findings

- Adalimumab achieved 60–85% clinical remission in moderate-to-severe Crohn's disease and axial spondyloarthritis.
- 1–3% of patients developed active TB despite screening and isoniazid prophylaxis.
- Region-specific frameworks are needed for safe adalimumab use in TB-endemic areas.

## Abstract

The management of Crohn's disease (CD) using anti-tumour necrosis factor therapy in tuberculosis (TB)-endemic regions poses major clinical challenges due to the risk of latent TB infection reactivation. This bibliometric–systematic literature review synthesised evidence from 17 peer-reviewed studies (2020–2025) evaluating adalimumab administered with concurrent prophylactic antitubercular therapy. Thematic synthesis and bibliometric mapping using VOSviewer demonstrated that adalimumab achieved 60–85% clinical remission in moderate-to-severe CD and axial spondyloarthritis while enhancing mucosal healing. However, 1–3% of patients developed active TB despite appropriate screening and isoniazid prophylaxis, revealing false-negative diagnostics and partial chemoprophylaxis protection. These findings highlight the need for region-specific frameworks integrating multimodal screening, targeted prophylaxis and ongoing clinical surveillance. Adalimumab remains a cornerstone biologic in TB-endemic settings, but its safe use requires adaptive, context-driven protocols emphasising vigilant risk mitigation.