Management of long-term therapy with biological drugs in psoriatic patients with latent tuberculosis infection in real life setting

Abstract

Psoriatic patients with latent tuberculosis infection (LTBI) need a prophylaxis before starting a treatment with biological drugs. The aim of this study is to investigate the safety and efficacy of prophylaxis of LTBI in psoriatic patients receiving long-term biological drugs. The study included 56 patients (42 male and 14 female) affected by moderate-to-severe psoriasis (mean PASI: 12.8 ± 6.9 SD) treated with anti-TNF-α and/or anti IL 12, 23 and/or anti-CD11 drugs with a diagnosis of LTBI. LTBI diagnosis was based on tuberculin skin test and/or QuantiFERON TB Gold test positivity and chest X-ray suggestive, without clinical, or microbiological evidence of active disease. All patients received prophylactic therapy for 9 months with isoniazid (INH) 300 mg/day, starting 3 weeks before the beginning of biological treatment. Fifty-four patients completed prophylaxis with INH without any adverse events or intolerance; they continue the biological treatment without appearance of active tuberculosis. One patient developed tuberculosis pleurisy in course of treatment with etanercept. The infection has been treated and after a stable remission, treatment was restarted without tuberculosis reactivation. In this retrospective analysis, the prophylaxis of LTBI whit INH was effective and safe in longer follow-up period.

Is chemoprophylaxis necessary for all latent tuberculosis infection patients receivingIL‐17 inhibitors? A cohort study

“…The use of biologics, particularly TNFα blockers in the treatment of chronic inflammatory diseases can increase five times the risk of developing active TB infection. [25][26][27] And the prophylaxis of LTBI with INH for 9 months was effective and safe in longer follow-up period with biologic drugs in psoriasis patients. 27 Therefore, screening and preventative measures for LTBI are mandatory in all patients commencing biologic treatment, especially in China.…”

Biologics and risk of tuberculosis in autoimmune rheumatic diseases: A real‐world clinical experience from India

“…Anti‐TNF and other biologics therapy in Italian patients with psoriasis and positive LTBI showed a significant reduction in TB onset with INH prophylaxis. In this cohort, one patient developed TB, despite prophylaxis …”

Incident tuberculosis disease in patients receiving biologic therapies in the Western Cape, South Africa from 2007 to 2018

“…For these reasons, guidelines recommend screening and prophylactic therapy for TB prior to initiation of biologic therapy [8,[15][16][17]. Biologic therapies specifically targeting tumour necrosis factor-alpha (TNF-α) are a recognised, independent risk factor for TB disease due to the central role of TNF-α in granuloma formation and maintenance [6,10].…”