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

Abstract

Background Tuberculosis (TB) screening is mandatory for psoriasis biologic treatment. However, evidences regarding TB screening results during biologic treatment are conflicting. Objectives The aim of this study is to evaluate the rate of QuantiFERON TB Gold test (QFT) conversion in psoriasis patients during biologics over time. Methods A 9‐year single center retrospective study was performed in order to evaluate the rate of QFT conversion in patients affected by moderate‐to‐severe plaque psoriasis under available biological therapies (anti‐TNF‐α, IL‐12/23, IL‐17). For each patient, demographic data, age, gender, comorbidities, previous psoriasis therapy, as well as ongoing treatment type were registered. Five‐hundred twenty‐six patients (61.2% male, with a mean age of 52.6 ± 13.9 years) treated with biologics were enrolled. Results QFT conversion occurred in 6.5% of patients over a mean treatment duration of 3.2 years. On average, QFT conversion occurred after 34.05 months of treatment. Anti‐TNF‐α drugs, and among them, adalimumab above all (35.5% of all cases), were the most commonly involved treatment during QFT conversion, followed by anti‐IL‐12/23 (17.6%) and anti‐IL‐17 (14.7%). However, differences among biologics class or single biologics (adalimumab, etanercept, infliximab, golimumab, certolizumab, ustekinumab, ixekizumab, secukinumab) did not approach statistical significance. Conclusions Annual TB screening is important in psoriasis patients under biologic treatment in order to avoid possible latent TB infection reactivation. Indeed, our data showed that even in a low TB prevalence country like Italy, QFT may convert over time in psoriasis patients under biologics in 6.5% of the cases.

The Tuberculosis Positive Conversion Rate Among Psoriasis Patients Treated with Adalimumab and Secukinumab: A Single-Center Retrospective Study in China

“…Parallel with previous real-world experience, we confirm the safety of SEC regarding TB activation among psoriasis patients [ 4 , 13 ]. In comparison, we recommend TB reevaluation in the first 3 months for patients treated with ADA in regions with high TB burden.…”

“…A long-term single-center retrospective study in the USA, an area with low TB risk, reported 1 LTBI case per 428 patient-years and no active TB cases among patients using biologic agents, including TNFi, IL-17i, and IL-12/23i [ 3 ]. In Italy, another area with low TB risk, a 9-year retrospective study indicated a 6.50% QFT conversion rate with no reports of active TB among psoriasis patients after a median of 34-month biological treatment [ 4 ]. Notably, the incidence of active TB is quite different in regions with median to high TB risk.…”

“…Biologic agents are pathogenesis-based therapeutic strategies that have revolutionized psoriasis treatment in the recent decades, and their use has grown widely because of efficacy and safety. However, there are still risks regarding their application in clinical practice [ 3 , 4 ]. In addition to common adverse effects such as upper tract infection and local injection reaction, tuberculosis (TB) infection remains a significant concern.…”

“…Recently, accumulating evidence based on real-world experience has illustrated the TB conversion rate among psoriasis patients treated with biologics in regions with low TB risk such as the USA and Italy. There are no reports of active TB, while the incidence of latent tuberculosis infection (LTBI) varies in these two regions [ 3 , 4 ]. Hence, the specific risk of LTBI or active TB among patients treated with biologics in different regions remains to be further explored.…”

Treatment with secukinumab for plaque psoriasis in patients with infectious comorbidities and latent tuberculosis: A multi‐case report analysis

“…Nonetheless, further research is needed to continuously improve patients' condition. 15 Preclinical data and growing real-life evidence demonstrate the safety profile of Secukinumab in patients treated with systemic therapy. 7,8,13 To prevent high toxicity prophylaxis in patients with comorbidities, treatment strategy guidelines are awaited.…”