A Propensity Score-Matched Study on the Changes of TB Status and TB-IGRA Values in Patients with Psoriasis with Latent TB Receiving Secukinumab

Abstract

Introduction The utilization of biologics in patients with psoriasis with latent tuberculosis infection (LTBI) has garnered significant attention. Although the tuberculosis (TB) safety profile of second-generation biologics, including secukinumab, has been partially confirmed in both clinical trials and real-world studies, the necessity for prophylactic therapy in patients with LTBI prior to administering this class of biologics remains a topic of controversy. Methods This study enrolled 62 patients with psoriasis with LTBI who underwent secukinumab with routine TB reexamination. Patients were divided into two groups based on whether they received antituberculosis therapy (ATB; n = 48) or not (NTB; n = 16). We performed a propensity score-matched (PSM) analysis between ATB and NTB subgroups and retrospectively reviewed their interferon-gamma release assays (IGRA) and radiographic results. Results No active TB case was reported on the basis of medical records and chest radiographs in either two group. Before PSM, the mean reexamining IGRA value was significantly elevated in patients who received prophylactic therapy ( P = 0.00), but no significant increase was observed in patients who were not. After PSM, there was no significant IGRA value enhancement whether or not patients received prophylactic treatment. Conclusion Our data provide additional information on the safety profile of secukinumab in patients with psoriasis with LTBI. Furthermore, our presentation of the reexamined IGRA results revealed no significant elevation in the ATB or NTB group. As such, we believe further exploration is necessary to determine whether anti-TB medication is required prior to administering secukinumab. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-023-00998-w.

Interleukin-17A Inhibitors in Patients with Psoriasis and Tuberculosis Infection: A 2-Year Prospective Study on Safety Without Preventive Treatment

“…Segueni et al found minimal changes in the transcriptomic levels of Il17 and Il23a in M. tuberculosis -infected mice, indicating a limited role for IL-17 pathways in controlling tuberculosis infection [ 11 ]. Shu et al and Xiao et al observed no ATB cases among patients with psoriasis and TBI treated with secukinumab without TPT over median follow-up of 52 weeks and 23 months, respectively [ 17 , 18 ]. Our study, with a larger sample size and longer follow-up duration, strengthens these consistent findings.…”

“…Additionally, QFT dynamics appear to be poorly correlated with the risk of ATB development [ 22 ]. A recent propensity score-matched study found no significant differences in QFT values before and after secukinumab treatment in patients with psoriasis and TBI for both the TPT and non-TPT groups [ 17 ]. Given these findings, continuous IGRA monitoring may not be essential for patients with psoriasis and TBI on IL-17A inhibitor therapy.…”