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Observational Study
. 2024 Mar;25(2):333-342.
doi: 10.1007/s40257-024-00845-4. Epub 2024 Jan 24.

Treatment of Psoriasis Patients with Latent Tuberculosis Using IL-17 and IL-23 Inhibitors: A Retrospective, Multinational, Multicentre Study

Tiago Torres  1   2 , Andrea Chiricozzi  3   4 , Luis Puig  5 , Ana Maria Lé  6 , Angelo Valerio Marzano  7   8 , Paolo Dapavo  9 , Esteban Dauden  10 , Jόse-Manuel Carrascosa  11 , Elizabeth Lazaridou  12 , Gleison Duarte  13 , André V E Carvalho  14 , Ricardo Romiti  15 , Natalia Rompoti  16 , Laetitia Teixeira  17   18 , Miguel Abreu  17   19 , Elena Ippoliti  3   4 , Carlo Alberto Maronese  7   8 , Mar Llamas-Velasco  10 , Eva Vilarrasa  5 , Elena Del Alcázar  11 , Athina-Ioanna Daponte  12 , Marina Papoutsaki  16 , Andrea Carugno  20 , Francesco Bellinato  21 , Paolo Gisondi  21
Affiliations
Observational Study

Treatment of Psoriasis Patients with Latent Tuberculosis Using IL-17 and IL-23 Inhibitors: A Retrospective, Multinational, Multicentre Study

Tiago Torres et al. Am J Clin Dermatol. 2024 Mar.

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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Conflict of interest statement

Tiago Torres declares the following conflicts of interest: AbbVie, Almirall, Amgen, Arena Pharmaceuticals, Biocad, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Fresenius Kabi, Janssen, LEO Pharma, Eli Lilly, MSD, Mylan, Novartis, Pfizer, Samsung-Bioepis, Sanofi-Genzyme, Sandoz and UCB. Andrea Chiricozzi has served as advisory board member and consultant and has received fees and speaker’s honoraria or has participated in clinical trials for AbbVie, Almirall, Bristol Myers Squibb, Leo Pharma, Lilly, Janssen, Novartis, Pfizer and Sanofi Genzyme. Luís Puig has received consultancy and/or speaker’s honoraria from and/or participated in clinical trials sponsored from AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Fresenius-Kabi, Janssen, JS BIOCAD, LEO Pharma, Lilly, Mylan, Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi and UCB. Ana Maria Lé has no conflicts of interest. Angelo Valerio Marzano reports consultancy/advisory board disease-relevant honoraria from AbbVie, Boehringer Ingelheim, Novartis, Pfizer, Sanofi and UCB. Paolo Dapavo has no conflicts of interest. Esteban Dauden has the following conflicts of interest: advisory board member, consultant, grants, research support, participation in clinical trials, honorarium for speaking, and research support, in connection with the following pharmaceutical companies: Abbvie/Abbott, Almirall, Amgen-Celgene, Janssen-Cilag, Leo-Pharma, Novartis, Pfizer, MSD-Schering-Plough, Lilly, UCB, Brystol-Myers and Boehringer Ingelheim. José-Manuel Carrascosa acted as a consultant and/or speaker for and/or participated in clinical trials sponsored by Janssen Pharmaceuticals Inc., Eli-Lilly, AbbVie, Novartis, Amgen, Leo-Pharma, UCB, Boehringer Ingelheim, Almirall, Sandoz and Bristol Myers Squibb. Elizabeth Lazaridou has the following conflicts of interest: speaker's honoraria from and participation in clinical studies and advisory boards with Abbvie, Leo, Novartis, Pfizer, UCB, Sanofi, Janssen, Lilly-Galderma, Pierre Fabre, L'Oreala and Galenica. Gleison Duarte is/has served as a scientific consultant, speaker or clinical trial investigator for Abbvie, Bayer, Janssen, Leo‐Pharma, Galderma, Sanofi, Boehringer, Novartis, Pfizer and UCB. André V. E. de Carvalho: Dr Carvalho acted as a consultant and/or speaker for and/or participated in clinical trials sponsored by companies that manufacture drugs used for the treatment of psoriasis, including Janssen Pharmaceuticals Inc., Eli-Lilly, AbbVie, Novartis, Amgen, Leo-Pharma, UCB and Boehringer Ingelheim. Ricardo Romiti has received consulting fees from AbbVie, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Galderma, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi, and UCB Pharma; his institution has received research grants from AbbVie; and he has served as a paid speaker for AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, LEO Pharma, Novartis, Pfizer, Sanofi and UCB Pharma. Natalia Rompoti has received honoraria for lectures from Janssen, AbbVie, Genesis Pharma, Leo, Lilly Pharmaserve, Novartis and UCB, and support for scientific congress attendance from AbbVie, Janssen, Leo, Lilly Pharmaserve, Novartis and UCB. Laetitia Teixeira has no conflicts of interest to declare. Miguel Abreu has no conflicts of interest to declare. Elena Ippoliti has no conflicts of interest to declare. Carlo Alberto Maronese has no conflicts of interest to declare. Mar Llamas-Velasco has the following conflicts of interest: advisory board member, consultant, grants, research support, participation in clinical trials, honorarium for speaking, research support, in connection with the following pharmaceutical companies: Abbvie, Almirall, Amgen, Biogen, Celgene, Janssen-Cilag, Leo Pharma, Lilly, MSD, Novartis, Pfizer, UCB, Kyowa Kirin, Brystol-Myers and Boehringer Ingelheim. Eva Vilarrasa has received honoraria for acting as a consultant and/or speaker for AbbVie, Almirall, Boehringer, Celgene, Janssen, Leo Pharma, Eli Lilly, MSD, Novartis, Pfizer and UCB. Elena del Alcázar has participated as an Secondary investigator and/or invited speaker for AbbVie, Janssen, Novartis, Lilly, Leo Pharma, Almirall, Amgen, UCB and Sanofi. Athina‑Ioanna Daponte has no conflicts to declare. Marina Papoutsaki has received honoraria for advisory boards and lectures from Janssen, Leo Pharma, MSD, Genesis Pharma, Pfizer, Novartis, AbbVie and UCB, and support as an investigator in clinical studies from AbbVie, Novartis, Leo Pharma and Janssen. Andrea Carugno has no conflicts of interest. Francesco Bellinato has no conflicts of interest. Paolo Gisondi has received honoraria for acting as a consultant and/or speaker for AbbVie, Almirall, Amgen, Biogen, Bristol Myers Squibb, Celgene, Janssen, LEO Pharma, Eli Lilly, MSD, Novartis, Pierre Fabre, Sanofi and UCB.

References

    1. MacNeil A, Glaziou P, Sismanidis C, Maloney S, Floyd K. Global epidemiology of tuberculosis and progress toward achieving global targets—2017. MMWR Morb Mortal Wkly Rep. 2019;68(11):263–266. - PMC - PubMed
    1. Ai J-W, Ruan Q-L, Liu Q-H, Zhang W-H. Updates on the risk factors for latent tuberculosis reactivation and their managements. Emerg Microbes Infect. 2016;5(2):e10. - PMC - PubMed
    1. Armstrong AW, Read C. Pathophysiology, clinical presentation, and treatment of psoriasis: a review. JAMA. 2020;323(19):1945–1960. - PubMed
    1. Gerdes S, Korber A, Biermann M, Karnthaler C, Reinhardt M. Absolute and relative psoriasis area and severity index (PASI) treatment goals and their association with health-related quality of life. J Dermatol Treat. 2020;31(5):470–475. - PubMed
    1. Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019;20(6):1–28. - PMC - PubMed

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