Background: The uses of the tumor necrosis factor- α inhibitors increase the risk of developing TB. However, there is limited information about the clinical outcomes of active TB followed by TNF inhibitors and the appropriateness of TNF inhibitors readministration. Thus, we analyzed the clinical characteristics and treatment response of patients who developed TB after treating TNF inhibitors. Methods: We retrospectively reviewed all patients diagnosed with active TB after receiving TNF inhibitor from January 2001 through August 2015 at two academic hospitals in Korea. Outcomes were assessed via the medical records, bacteriological and radiologic findings and the response to anti-TB treatment. Results: 23 patients(1.4%) developed TB during a median of 316 days of TNF inhibitors. The LTBI screening was performed in all 23 patients and LTBI was diagnosed in 4 patients. In these patients, TB disease occurred even after LTBI treatment. Favorable course were showed in 21(91%) of 23 patients after administering first-line anti-TB medication, although 2 patients developed MDR TB. The 10 patients were retreated with TNF inhibitors: 6 patients were restarted during anti-TB treatment and the other 4 patients were reinitiated after completion of anti-TB medication. No TB recurrence was reported in the patients of resuming TNF inhibitors during a median follow-up of 26 months. Conclusions: We suggest that more specific protocol for diagnosis of LTBI and TB is required before and during TNF inhibitors. And recommencing TNF inhibitors may be considered and safe during the anti-TB medication