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

Abstract

The use of a screening tool for LTBI is mandatory in patients taking biologic therapies to avoid severe infectious complications. Periodic follow-up is also crucial as positive results may be seen after prolonged use of these agents.

QuantiFERON TB‐gold conversion rate among psoriasis patients under biologics: a 9‐year retrospective study

“…The aim of the screening before the treatment start and during the follow‐up is to detect a possible quiescent state of the Mycobacterium tuberculosis infection called latent tuberculosis infection (LTBI) 1 . Opportunistic infections reactivation, especially LTBI, is one of the main risks during biologic therapy, in particular with TNF‐α inhibitors 2‐4 . TNF‐α, an inflammatory cytokine that plays a central role in the pathogenesis of psoriasis, is also involved in the control of bacterial infections and granuloma formation to limit pathogens dissemination.…”

“…Also, IL‐12 and IL‐23 play an important role in the immunologic barrier against bacterial or parasitic infections 5 . For these reason, TB screening and eventual TB infection prophylaxis in case of screening positivity for LTBI are mandatory before starting a biologic treatment 2,3 . Among TNF‐α inhibitors, etanercept (a soluble TNF‐α receptor) is associated with a lower risk of reactivation than infliximab and adalimumab (monoclonal antibodies) because of a probable reduced interference with granuloma formation and higher clearance rate 6 .…”

“…Epidemiological studies reported a LTBI prevalence rate of 5‐22% in Italy, 10% in United Kingdom, 11% in Taiwan, and 20–29% in Spain, respectively, in psoriatic patients screened for TB 2,3 . Italy is a low‐burden country for TB with a prevalence rate of 7.7 cases per 100,000 3 .…”

Biological Drug Use in Patients with Psoriasis: Our Clinical Experiences

“…14 In a study conducted in the USA where patients with psoriasis were evaluated before the biological drug treatment, the rate of latent tuberculosis was examined by the tuberculin test and found to be positive in about 4.5% of the cases. 15 In a study in Italy this rate was found to be 8.2%. 14 In this study, latent tuberculosis infection was diagnosed in the clinic for chest diseases by clinical evaluation, ppd / quantiferon test and chest x-ray.…”

Tuberculosis Screening in Patients with Psoriasis Receiving Biologic Therapy: A Retrospective Cohort Study

“…Studies report a highly heterogeneous TST positivity rate in patients with psoriasis, ranging between 4.5% and 99% (7,8). The present study was conducted in Israel, where the tuberculosis burden is low (4:100,000) (6).…”