Anti–tumor necrosis factor therapy and interpreting tuberculin skin tests

Brown, Allison J.; Lesher, Jack L.

doi:10.1016/j.jaad.2008.12.024

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…The consensus guidelines from the National Psoriasis Foundation, USA, state that an induration >5 mm is classified as positive in patients with immunosuppression, including patients who are receiving TNF antagonists [7]. The main disadvantage is that they do not provide specific guidelines on interpreting TST for patients about to start anti-TNF therapy [8]. Some authors consider that skin indurations of 5 mm or greater should be interpreted as a positive result for LTBI in any patient considered for TNF blockade [65].…”

Section: Discussionmentioning

confidence: 99%

Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review

Solovan

Chiticariu

2013

Infect Dis Ther

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IntroductionThe era of biologic therapies has provided new options for the treatment of chronic plaque psoriasis. However, safety concerns have led to intensive screening and monitoring of patients receiving anti-tumor necrosis factor alpha (anti-TNF-alpha) agents.MethodsThe authors describe the cases of three patients with moderate to severe psoriasis treated with anti-TNF agents, with challenging diagnostic and treatment aspects regarding tuberculosis (TB) infection, a serious adverse event associated with this type of treatment. The cases are discussed in the context of a comprehensive literature review describing the risk of TB associated with the use of TNF inhibitors. A critical review of the clinical trials that have tested the safety of these agents is also presented.ResultsOne patient, who tested negatively for latent TB infection (LTBI) during screening, developed active TB under adalimumab therapy. For two other patients the diagnosis and management of LTBI in relation to anti-TNF therapy represented a challenge. Although clinical trials involving the use of anti-TNF therapy for psoriasis haven’t demonstrated a high TB incidence, active TB is continuously reported in association with this treatment.ConclusionsFindings from clinical practice and the scientific literature indicate that anti-TNF therapies are associated with an increased risk of TB, and close monitoring of patients is needed.

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Section: Discussionmentioning

confidence: 99%

Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review

Solovan

Chiticariu

2013

Infect Dis Ther

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“…2 In addition to the importance of screening for tuberculosis infection before antieTNF-alfa therapy, previous articles have brought attention to the lack of consensus in the literature on the interpretation of tuberculin skin testing (TST) in patients with psoriasis. [3][4][5] For patients with psoriasis on long-term antieTNF-alfa therapy, recent American Academy of Dermatology guidelines also recommend TST on an annual basis. 6 There is, however, some clinical evidence indicating that TST may not be reliable in patients already receiving antieTNF-alfa therapy.…”

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confidence: 99%

Is tuberculin skin testing reliable during anti–tumor necrosis factor-alfa therapy? A case report and review of the literature

Haddican

Koo

2011

Journal of the American Academy of Dermatology

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Biologic Therapies in the Treatment of Psoriasis: A Comprehensive Evidence-Based Basic Science and Clinical Review and a Practical Guide to Tuberculosis Monitoring

Sivamani

Goodarzi

Garcia

et al. 2012

Clinic Rev Allerg Immunol

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The treatment of psoriasis has undergone a revolution with the advent of biologic therapies including infliximab, etanercept, adalimumab, efalizumab, golimumab, certolizumab, alefacept, secukinumab, abatacept, and ustekinumab. These medications are designed to target specific components of the immune system and are a major technological advancement over traditional immunosuppressive medications. Herein, we present a comprehensive, unbiased comparison of these medications focusing on their differences. For example, TNF antagonists can differ in the way they are dissolved and administered, the effector molecules they can bind, serum peak and trough levels, the types of intracellular signals they can induce, the in vivo complexes that they can form, their protein structure, and their incidence and timing of rare adverse events, among other things. A critical review of the clinical studies that have tested the efficacy of these molecules is also presented including head-to-head comparison trials. The safety of biologics in terms of their long-term adverse events is discussed, as is their use in different types of psoriasis and in different patient populations. Finally, all anti-TNF agents have been associated with a variety of serious and "routine" opportunistic infections, particularly tuberculosis. For this reason, anti-tuberculosis testing both prior to the initiation of a biologic therapy and annually during treatment is pertinent. The uses and limitations of both the tuberculin skin test (TST) and QuantiFeron®-TB Gold (QFT) are discussed, as is the care of patients who present with latent tuberculosis infection prior to the initiation of biologic therapy. Recommendations for tuberculosis monitoring are provided.

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Anti–tumor necrosis factor therapy and interpreting tuberculin skin tests

Cited by 3 publications

References 3 publications

Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review

Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review

Is tuberculin skin testing reliable during anti–tumor necrosis factor-alfa therapy? A case report and review of the literature

Biologic Therapies in the Treatment of Psoriasis: A Comprehensive Evidence-Based Basic Science and Clinical Review and a Practical Guide to Tuberculosis Monitoring

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