Treatment of Psoriasis Patients with Latent Tuberculosis Using IL-17 and IL-23 Inhibitors : A Retrospective, Multinational, Multicentre Study
Torres, Tiago (University of Porto, Portugal)
Chiricozzi, Andrea (Università Cattolica del Sacro Cuore, Rome, Italy)
Puig Sanz, Lluís (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Lé, Ana Maria (Centro Académico Clínico ICBAS - CHP, Porto, Portugal)
Marzano, Angelo Valerio (Università degli Studi di Milano, Italy)
Dapavo, Paolo (University of Turin, Italy)
Dauden, Esteban (Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa (IIS-IP), Madrid)
Carrascosa, José Manuel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Lazaridou, Elizabeth (Aristotle University School of Medicine, Thessaloniki, Greece)
Duarte, Gleison (Instituto Bahiano de Imunoterapias-IBIS, Salvador, Brazil)
Carvalho, André V. E. (Hospital Moinhos de Vento, Porto Alegre, Brazil)
Romiti, Ricardo (University of São Paulo, Brazil)
Rompoti, Natalia (University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece)
Teixeira, Laetitia (Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal)
Abreu, Miguel (University of Porto, Portugal)
Ippoliti, Elena (Università Cattolica del Sacro Cuore, Rome, Italy)
Maronese, Carlo Alberto (Università degli Studi di Milano, Italy)
Llamas-Velasco, Mar (Hospital Universitario de la Princesa (Madrid))
Vilarrasa-Rull, Eva (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
del Alcázar, Elena (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Daponte, Athina-Ioanna (Aristotle University School of Medicine, Thessaloniki, Greece)
Papoutsaki, Marina (University of Athens, 'A. Sygros' Hospital for Skin and Venereal Diseases, Athens, Greece)
Carugno, Andrea (ASST Papa Giovanni XXIII, Bergamo, Italy)
Bellinato, Francesco (University Hospital of Verona (Itàlia))
Gisondi, Paolo (University Hospital of Verona (Itàlia))
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2024
Resum:	Tuberculosis has a major global impact. Immunocompetent hosts usually control this disease, resulting in an asymptomatic latent tuberculosis infection (LTBI). Because TNF inhibitors increase the risk of tuberculosis reactivation, current guidelines recommend tuberculosis screening before starting any biologic drug, and chemoprophylaxis if LTBI is diagnosed. Available evidence from clinical trials and real-world studies suggests that IL-17 and IL-23 inhibitors do not increase the risk of tuberculosis reactivation. To evaluate psoriasis patients with treated or untreated newly diagnosed LTBI who received IL-17 and IL-23 inhibitors and the tolerability/safety of tuberculosis chemoprophylaxis. This is a retrospective, observational, multinational study from a series of 14 dermatology centres based in Portugal, Spain, Italy, Greece and Brazil, which included adult patients with moderate-to-severe chronic plaque psoriasis and newly diagnosed LTBI who were treated with IL-23 or IL-17 inhibitors between January 2015 and March 2022. LTBI was diagnosed in the case of tuberculin skin test and/or interferon gamma release assay positivity, according to local guideline, prior to initiating IL-23 or IL-17 inhibitor. Patients with prior diagnosis of LTBI (treated or untreated) or treated active infection were excluded. A total of 405 patients were included; complete/incomplete/no chemoprophylaxis was administered in 62. 2, 10. 1 and 27. 7% of patients, respectively. The main reason for not receiving or interrupting chemoprophylaxis was perceived heightened risk of liver toxicity and hepatotoxicity, respectively. The mean duration of biological treatment was 32. 87 ± 20. 95 months, and only one case of active tuberculosis infection (ATBI) was observed, after 14 months of treatment with ixekizumab. The proportion of ATBI associated with ixekizumab was 1. 64% [95% confidence interval (CI): 0-5. 43%] and 0% for all other agents and 0. 46% (95% CI 0-1. 06%) and 0% for IL-17 and IL-23 inhibitors, respectively (not statistically significant). The risk of tuberculosis reactivation in patients with psoriasis and LTBI does not seem to increase with IL-17 or IL-23 inhibitors. IL-17 or IL-23 inhibitors should be preferred over TNF antagonists when concerns regarding tuberculosis reactivation exists. In patients with LTBI considered at high risk for developing complications related to chemoprophylaxis, this preventive strategy may be waived before initiating treatment with IL-17 inhibitors and especially IL-23 inhibitors.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	American Journal of Clinical Dermatology, Vol. 25, Num. 2 (march 2024) , p. 333-342, ISSN 1179-1888

DOI: 10.1007/s40257-024-00845-4
PMID: 38265746

10 p, 673.5 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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