Patients starting most immunomodulators and TNF inhibitors should have a tuberculin skin test at the end of treatment?

Patients starting most immunomodulators and TNF inhibitors should have a tuberculin skin test before beginning treatment to screen for latent tuberculosis infection, not at the end of treatment. This screening is crucial because both immunomodulators and TNF inhibitors can increase the risk of reactivation of latent tuberculosis. Therefore, the correct approach is to perform the tuberculin skin test prior to the initiation of therapy, in order to identify any patients who may require treatment for latent TB before commencing immunosuppression. Conducting the test at the end of treatment would not provide the necessary preventative care and risk assessment at the appropriate time.