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Treatment of psoriasis with biologic and non-biologic targeted therapies in patients with latent tuberculosis infection or at risk for tuberculosis disease progression: Recommendations from a SPIN-FRT expert consensus.
Torres, T; Brembilla, N C; Langley, R G; Warren, R B; Thaçi, D; Kolios, A G A; Prinz, J C; Londono-Garcia, A; Nast, A; Santin, M; Goletti, D; Abreu, M; Spuls, P; Boehncke, W H; Puig, L.
Afiliación
  • Torres T; Department of Dermatology, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
  • Brembilla NC; Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal.
  • Langley RG; Division of Dermatology and Venereology, University Hospitals of Geneva, Geneva, Switzerland.
  • Warren RB; Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Thaçi D; Division of Clinical Dermatology & Cutaneous Science, Dalhousie University, Halifax, Nova Scotia, Canada.
  • Kolios AGA; Dermatology Centre, Northern Care Alliance NHS Foundation Trust, Manchester, UK.
  • Prinz JC; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
  • Londono-Garcia A; Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lü beck, Germany.
  • Nast A; Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
  • Santin M; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Goletti D; University Hospital, Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Munich, Germany.
  • Abreu M; Dermatology Research Group, CES University, Medellin, Colombia.
  • Spuls P; Division of Evidence-Based Medicine, Department of Dermatology, Venereology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Boehncke WH; Tuberculosis Unit, Department of Infectious Diseases, Bellvitge University Hospital-Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
  • Puig L; Department of Clinical Sciences, L'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain.
Article en En | MEDLINE | ID: mdl-39149807
ABSTRACT
Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a significant global health problem. In immunocompetent individuals, the microorganism can remain in a latent, non-contagious form, however, it may become active under conditions of immunosuppression. Tumour necrosis factor (TNF) inhibitors, which are frequently used for the management of immune-mediated disorders like psoriasis, have been associated with a significantly increased risk of reactivating latent TB. Consequently, international guidelines recommend TB screening and preventive treatment before starting anti-TNF therapy. These recommendations have extended to IL-12/23, IL-17, IL-23 and TYK2 inhibitors under a caution principle, despite their different mechanisms of action. However, current evidence suggests that some of these agents are arguably not associated with an increased risk of TB reactivation or development of TB disease after infection, which calls for a critical reassessment of these guidelines. We have conducted a literature search evaluating the risk of TB reactivation associated with these innovative therapies, integrating findings from both randomized clinical trials and real-world evidence. The identified evidence is limited but the low number of identified cases of reactivation with IL-17 and IL-23 inhibitors prompts reconsidering the need for preventive treatment for latent TB in all cases, regardless of biologic class or individual patient's risk of TB reactivation or drug toxicity. This review, along with the clinical insight of a panel of experts on behalf of the SPIN-FRT, led to the development of these consensus recommendations for managing psoriasis treatment in patients with latent TB infection or at risk of TB infection, who are receiving or are intended to receive biologic and non-biologic targeted therapies. These recommendations highlight the need for updates to the existing guidelines, aiming to provide a more differentiated approach that reflects the evolving landscape of psoriasis treatment and its implications for TB management.

Texto completo: 1 Bases de datos: MEDLINE Idioma: En Revista: J Eur Acad Dermatol Venereol Asunto de la revista: DERMATOLOGIA / DOENCAS SEXUALMENTE TRANSMISSIVEIS Año: 2024 Tipo del documento: Article País de afiliación: Portugal

Texto completo: 1 Bases de datos: MEDLINE Idioma: En Revista: J Eur Acad Dermatol Venereol Asunto de la revista: DERMATOLOGIA / DOENCAS SEXUALMENTE TRANSMISSIVEIS Año: 2024 Tipo del documento: Article País de afiliación: Portugal