Serial Quantiferon‐TB Gold test results in 279 patients with psoriasis receiving biologic therapy

Abstract

The risk of active tuberculosis is still a concern in patients receiving biologics. To determine the risk of latent tuberculosis infection (LTBI) reactivation by Quantiferon‐TB Gold (QFT) assay in psoriatic patients treated with biologics in 11 years' follow‐up, along with chest radiography alterations. This retrospective study included 279 patients with plaque‐type and/or pustular, or nail psoriasis who were treated with biologics, and had results for ≥2 LTBI tests. The QFT outcomes were defined according to the baseline and the follow‐up QFT results; seroconversion as from negative to positive, seroreversion as from positive to negative, persistently seronegative as invariantly negative, persistently seropositive as invariantly positive, and other any result was accepted as indeterminate. Demographic features, the presence and the type of any chest X‐ray abnormality was noted during the follow‐up. Of 279 baseline QFT tests, the vast majority were negative (n = 193; 69%), with a less of positive (n = 86; 31%). Ten (5.2%) of 193 patients converted from negative to positive QFT status after starting biologic therapy (P < 0.001) during 11 years' follow‐up. Although these 10 patients exhibited seroconversion of QFT from negative to positive, only one patient was diagnosed with active TB. There was no statistically significant difference among biologics as regards with QFT seroconversion risk (P = .09). This study showed that 5.2% of patients showed seroconversion. Annual QFT testing remains a necessary and mandatory tool to prevent further TB reactivation in psoriasis patients taking biologic therapy although only one patient was diagnosed with active TB in this cohort.

Risk of tuberculosis infection and serial changes in interferon‐gamma release assays in elderly patients with psoriasis receiving biologic therapy

“…22 In Turkey, of the 279 patients with psoriasis treated with biologic agents, one (0.36%) patient who received TNFα inhibitor therapy developed active TB. 10 The active TB rate tends to be highest in studies with a high proportion of patients with LTBI. 19 In our study, 2/90 (2.22%) patients, each of whom received adalimumab and ustekinumab, respectively, developed active TB.…”

“…Biologics are considered safer and more effective than conventional systemic treatments, but the risk of developing TB infection remains a major concern. 10 TB may develop as an active infection or as an LTBI. In LTBI, a small number of viable TB bacilli that are undetectable on microbiological examination are believed to reside in affected patients without causing any clinical symptoms or radiological abnormalities.…”

“…10 Studies from the United States have revealed a 0.2%-0.5% IGRA seroconversion rate in patients with psoriasis treated with biologics. 10,30 A study performed by Sakae et al in Japan revealed that 2/1052 patients (0.19%), maintained on ustekinumab and infliximab, respectively, experienced seroconversion. 21 Compared to the low seroconversion rates reported in these countries, higher seroconversion rates of 6%-11.1%, 1.3%-14.3%, and 5.2% have been reported in other studies on patients with psoriasis treated with biologics from Italy, Taiwan, and Turkey, respectively.…”

“…21 Compared to the low seroconversion rates reported in these countries, higher seroconversion rates of 6%-11.1%, 1.3%-14.3%, and 5.2% have been reported in other studies on patients with psoriasis treated with biologics from Italy, Taiwan, and Turkey, respectively. 10,20,31 This is the first study to evaluate the risk of TB infection as well as serial changes in IGRA findings in elderly patients with psoriasis receiving biologic therapy. However, there are some limitations to this study.…”

“…Biologics are considered safer and more effective than conventional systemic treatments, but the risk of developing TB infection remains a major concern 10 . TB may develop as an active infection or as an LTBI.…”