Latent tuberculosis infection in psoriasis patients using bio treatments

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This study looked at latent tuberculosis infection in psoriasis patients using biological therapy, and compares them with patients with crohn's disease, rheumatoid arthritis, and healthcare workers.

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Background:
Screening for latent tuberculosis infection (LTBI) is mandatory in patients with psoriasis prior to biological therapy.

Objective:
Investigate the prevalence of LTBI in patients with psoriasis candidate to biological therapy.

Methods:
LTBI was investigated in patients with moderate-to-severe psoriasis (n=243), Crohn's disease (n=64) or rheumatoid arthritis (n=56) (RA) and in healthcare workers (n=1683). LTBI diagnosis was based on positive QuantiFERON-TB-Gold in tube (QFT) in vitro assay without any clinical, radiological or microbiological evidence of active tuberculosis.

Results:
LTBI was diagnosed in 8.2% of patients with psoriasis, 6.5% with Crohn's disease, 8.9% with RA and in 8.8% healthcare workers (p=0.9). Psoriatic patients with LTBI (n=20) received a 9-months prophylaxis with isoniazid (5 mg/kg/day) and no one developed active tuberculosis infection after receiving biological therapy (etanercept, adalimumab, infliximab or ustekinumab) for 37 ± 32 weeks (mean ± SD). All psoriatic patients were re-tested for LTBI after 31 ± 1.7 months. Five patients out of 20 with LTBI presented QFT reversion and 2 patients out of 243 (0.8%) had QFT conversion and received antibiotic prophylaxis.

Conclusions:
Prevalence of LTBI in patients with psoriasis is similar to patients with Crohn's disease, RA and healthcare workers. Prophylaxis with isoniazid is effective in preventing tuberculosis reactivation in patients with LTBI receiving biological therapy.

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