Association between different systemic therapies and the risk of tuberculosis in psoriasis patients: A population‐based study

Abstract

Tuberculosis (TB) contributes to a major public health issue worldwide, and its risk increases when the host immune system is impaired. This could be attributed to an underlying chronic disease, an immunologic disorder or use of immunosuppressants. [1][2][3][4][5] Psoriasis is a chronic inflammatory skin disorder that involves a complex interplay of cytokines, immune cells and the cutaneous tissue. In addition to newer biologic agents that target specific molecules in the pathogenesis of psoriasis, the use of traditional immunosuppressants still accounts for a considerable proportion of systemic treatment. 6,7 Muddasani et al estimated that methotrexate (MTX), one of the widely used systemic antipsoriasis drugs, was prescribed in an estimated 2 million visits during a 10-year follow-up period. 8 The risk of TB was higher in psoriasis patients than that in the general population. 9 The systemic therapy for psoriasis, especially those agents with immunosuppressive effects, could contribute to additional risk for TB infection and reactivation. To investigate the real-world association between the traditional systemic anti-psoriasis therapies and the risk of TB, we design this study by using a nationwide population-based cohort with time-varying covariates.

Risk of Reactivation of Latent Tuberculosis in Psoriasis Patients on Biologic Therapies: A Retrospective Cohort from a Tertiary Care Centre in Northern Italy

“…With methotrexate, an increased risk of tubercular reactivation is evidenced ( 23 ). The frequent use of this treatment before initiation of biological therapy may cause confusion regarding which drugs cause LTBI reactivation.…”

Latent Tuberculosis Infection and Associated Factors in Patients with Systemic Lupus Erythematosus: a Multicenter, Cross-Sectional Study

“…FK506, a calcineurin inhibitor, can effectively inhibit the production of IL-2, IL-4, and IL-3; furthermore, it can inhibit the proliferation and the activation of T cells ( 30 ). A prospective cohort study of psoriasis patients in Taiwan showed that patients treated with FK506 had a higher risk of tuberculosis (hazard ratio [HR], 5.31; 95% CI, 1.66 to 17.01) ( 31 ). It is evident that LEF and FK506 will significantly increase the risk of ATB in patients with autoimmune diseases, while they tend to produce negative T-SPOT.TB results.…”

Latent Tuberculosis in Psoriasis Patients on Biologic Therapies: Real-World Data from a Care Center in Romania

“…At the same time, it is established that MTX raises the risk of TB [ 18 , 19 , 20 ]. As many of the patients with moderate and severe psoriasis were treated with MTX before starting biological therapy, it cannot be known for sure which of the drugs induced the appearance of LTBI.…”