Latent tuberculosis infection in patients with chronic plaque psoriasis who are candidates for biological therapy

Gisondi, Paolo; Pezzolo, Elena; Cascio, Giuliana Lo; Girolomoni, Giampiero

doi:10.1111/bjd.13130

Cited by 26 publications

(16 citation statements)

References 35 publications

(41 reference statements)

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“…1 There is an increasing proportion of cases among immigrants, which reached 67Á5% of total confirmed TB cases in northern Italian regions. 2 There are relatively scarce data regarding the prevalence of latent TB infection (LTBI) in patients with psoriasis, [3][4][5][6][7] and the nationwide prevalence of patients with LTBI with moderate-to-severe psoriasis, candidate to systemic treatment has not previously been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Recent epidemiological studies reported a prevalence rate of LTBI in patients with psoriasis of 5-22% in Italy, [3][4][5][6][7]23 11% in Taiwan 24 and 20-29% in Spain, which is a high-prevalence country for TB. 25,26 LTBI was diagnosed by TST in 13Á4% of patients with rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis) undergoing treatment with infliximab in Spain.…”

Section: Discussionmentioning

confidence: 99%

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Latent tuberculosis infection in patients with chronic plaque psoriasis: evidence from the Italian Psocare Registry

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Latent tuberculosis infection in patients with chronic plaque psoriasis: evidence from the Italian Psocare Registry

et al. 2015

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“…TB reactivation is frequently extrapulmonary and disseminated. In Italy the prevalence of latent TB in patients with moderate‐to‐severe psoriasis is 8.2% . Screening for LTBI is mandatory in patients who are candidate to biologics because of increased risk of LTBI reactivation, particularly with TNF‐α inhibitors.…”

Section: Resultsmentioning

confidence: 99%

“…In Italy the prevalence of latent TB in patients with moderate-to-severe psoriasis is 8.2%. 99 Screening for LTBI is mandatory in patients who are candidate to biologics because of increased risk of LTBI reactivation, particularly with TNF-a inhibitors. Although the risk of LTBI reactivation significantly differs among biologics, caution and vigilance are required for all biologics.…”

Section: Patients With Latent Tuberculosis Infectionmentioning

confidence: 99%

Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

Gisondi

Altomare

Ayala

et al. 2017

Acad Dermatol Venereol

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Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.

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“…The incidence of tuberculosis is estimated in seven new cases per 100,000 people per year in Italy (http://www. In literature there are data on incidence of tuberculosis infection in psoriatic patients, but there are limited reports on efficacy of prophylaxis of LTBI in psoriatic patients treated for long-time with biological drugs Gisondi, Pezzolo, Lo Cascio, & Girolomoni, 2014;Laffitte et al, 2009). The use of biologics, particularly TNF-a inhibitors (infliximab, etanercept, and adalimumab) in the treatment of chronic inflammatory diseases can increase five times the risk of developing active tuberculosis in these patients by the fragmentation of TNF-dependent granulomas (Amerio et al, 2013;Gardam et al, 2003;Hernandez, Cetner, Jordan, Puangsuvan, & Robinson, 2009;Keane & Bresnihan, 2008;National Psoriasis Foundation, 2008;World Health Organization, 2015).…”

Section: Introductionmentioning

confidence: 99%

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

Conti

Piaserico

Gisondi

et al. 2017

Dermatologic Therapy

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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.

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Latent tuberculosis infection in patients with chronic plaque psoriasis who are candidates for biological therapy

Abstract: The prevalence of LTBI in patients with psoriasis is similar to that in patients with Crohn disease or RA and in healthcare workers. Prophylaxis with isoniazid is effective in preventing tuberculosis reactivation in patients with LTBI receiving biological therapy.

Cited by 26 publications

References 35 publications

Latent tuberculosis infection in patients with chronic plaque psoriasis: evidence from the Italian Psocare Registry

Latent tuberculosis infection in patients with chronic plaque psoriasis: evidence from the Italian Psocare Registry

Italian guidelines on the systemic treatments of moderate‐to‐severe plaque psoriasis

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

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