Patients with Psoriasis are More Likely to be Treated for Latent Tuber­culosis Infection Prior to Biologics than Patients with Inflammatory Bowel Disease

Abstract

Screening for latent tuberculosis infection (LTBI) is recommended before treatment with biologics is initiated in patients with psoriasis or inflammatory bowel disease (IBD). Our objective was to evaluate the effect of underlying disease (psoriasis or IBD) on the risk of LTBI diagnosis prior to anti-tumor necrosis factor-alpha (TNF-α) therapy. During a two-year period LTBI diagnosis rate was compared in consecutive patients with psoriasis or IBD (Crohn's disease or ulcerative colitis). IBD patients (n = 33) had significantly smaller tuberculin skin testing compared to psoriasis patients (n = 30) (p = 0.007). Applying LTBI diagnosis guidelines resulted in more psoriasis (50%) than IBD patients (24.2%) receiving treatment for LTBI prior to onset of anti-TNF-α treatment (p = 0.04). In conclusion, current recommendations for LTBI diagnosis must be re-evaluated to account for the unique tuberculin hyperactive state of the skin of patients with psoriasis.

Prevalence of latent tuberculosis infection in patients with moderate to severe psoriasis taking biologic therapies in a dermatologic private practice in Miami, Florida

“…19,20 These authors attribute this observation to the unique tuberculin hyperactive state of the skin of patients with psoriasis. Based on these studies, psoriasis itself can be considered a risk factor for LTBI.…”

Reactivation of Tuberculosis in Three Cases of Psoriasis after Initiation of Anti-TNF Therapy

“…Screening for LTBI before treatment with anti-TNF agents in psoriasis patients showed varying results [3, 5, 6]. The frequency of LTBI in patients with psoriasis after initiation of anti-TNF therapy is also variable across different studies [9, 10, 11].…”

“…Studies on risk factors causing TB did not show that psoriatic patients are at greater risk of acquiring TB compared to the general population; however, psoriatic patients are more likely to be treated for latent TBI (LTBI) before anti-TNF therapy compared to patients with inflammatory bowel disease [3]. Moreover, in one study the in vitro T cell responsiveness was diminished towards Mycobacterium tuberculosis in cases with severe psoriasis [4].…”

“…Before initiation of anti-TNF therapy in psoriatic patients, screening for LTBI using the tuberculin skin test (TST), interferon gamma release assay (IGRA) and chest X-ray (CXR) revealed a positive reaction in about 20% of the cases in the 2009 Swiss study by Laffitte et al [5]. In a study from Greece using TST alone, 50% of the patients showed a positive tuberculin test [3]. In a wide-scale study from Italy using IGRA and involving 405 psoriatic patients, 18% of the samples showed a positive reaction [6].…”

Psoriatic Disease and Tuberculosis Nowadays

“…A similar result is reported by Bassukas et al during a two-year period, LTBI diagnosis rate was compared in consecutive patients with psoriasis or inflammatory bowel disease like Crohn's disease or ulcerative colitis: these patients had significantly smaller tuberculin skin testing compared to psoriasis patients ( P = 0.007). Applying LTBI diagnosis guidelines, latent infection resulted in more psoriasis (50%) than inflammatory bowel disease patients (24.2%), prior to onset of any anti-TNF- α treatment ( P = 0.04) [42]. A recent survey concerning the evaluation of the infectious complications during biological therapy of psoriasis showed a rate of infections of 12.24%, with only one case of pulmonary TB, out of 988 patients [43].…”