Psoriatic Disease and Tuberculosis Nowadays

Abstract

Psoriasis is a chronic, relapsing and remitting inflammatory skin and joint disease that has a prevalence of 2-3% in the world's population, whereas of 1–2% in Europe. The traditional concept of psoriasis as the “healthy people's” disease has been recently revised because of ever-increasing reports of associations with various pathological conditions (hypertension, Crohn's disease, type II diabetes mellitus, obesity, dyslipidemia, metabolic syndrome, infectious conditions). Particularly, advances in psoriasis therapies have introduced biologic agents. All the tumor necrosis factor-alpha inhibitors are associated with an increased risk of developing active disease in patients with latent tuberculosis infection, because of TNF-α key role against Mycobacterium tuberculosis. For this reason, exclusion of active tuberculosis and treatment of latent tuberculosis infection are clinical imperatives prior to starting this therapy. Moreover active surveillance for a history of untreated or partially treated tuberculosis or latent form has already been shown to be effective in reducing the number of incident tuberculosis cases.

Infections from seven clinical trials of ixekizumab, an anti-interleukin-17A monoclonal antibody, in patients with moderate-to-severe psoriasis

“…Serious infections have also been reported, but with a low incidence . An increased risk of developing active tuberculosis (TB) has been observed with some tumour necrosis factor (TNF)‐α blockers . Opportunistic fungal infections (e.g.…”

The risk of deep fungal infections during biologic therapy for psoriasis

“…The TNF inhibitors have been associated with an increased risk of developing active TB in patients with latent infection, believed to be due to the key role of TNF against infection with Mycobacterium tuberculosis. 2 Therefore, exclusion of active TB and treatment of latent TB infection are considered imperative prior to beginning biologic therapy. This may be particularly important as Bordignon et al 5 has reported an unexpected high prevalence (18%) of latent TB among psoriatics, and Ramagopalan et al 6 has reported an increased risk of TB following hospital admission for psoriasis in the United Kingdom.…”

“…Certain biologics have been associated with an increased risk of reactivating Mycobacterium tuberculosis (TB) infection in patients with latent disease . However, with increasing use of biologic agents across indications, there has also been a rise in reports of associated deep fungal infections.…”

“…The TNF inhibitors have been associated with an increased risk of developing active TB in patients with latent infection, believed to be due to the key role of TNF against infection with Mycobacterium tuberculosis . Therefore, exclusion of active TB and treatment of latent TB infection are considered imperative prior to beginning biologic therapy.…”

“…1 Certain biologics have been associated with an increased risk of reactivating Mycobacterium tuberculosis (TB) infection in patients with latent disease. 2 However, with increasing use of biologic agents across indications, there has also been a rise in reports of associated deep fungal infections. From the late 1990s through July 2001, there were only 10 cases of histoplasmosis reported to the United States Food and Drug Administration (FDA) Adverse Events Reporting System, and this number has risen to 240 cases associated with TNF inhibitor use among various diseases, as of September 2008.…”