Pescitelli Leonardo, Ricceri Federica, Prignano Francesca
Address correspondence to Dr. Prignano, Division of Clinical, Preventive and Oncology Dermatology, Department of Surgery and Translational Medicine, Florence University, Ospedale Piero Palagi, V.le Michelangelo 41, 50125 Florence, Italy. E-mail:
J Rheumatol Suppl. 2014 May;91:65-70. doi: 10.3899/jrheum.140104.
The treatment of some dermatological diseases, especially psoriasis, has been revolutionized by the advent of biologic therapies that target various immune cells or cytokines. However, biologic therapies may affect the risk of active tuberculosis (TB). We review the published safety data about TB risk reactivation for biologic agents used in dermatology. According to recent findings, psoriasis itself could represent an independent risk factor for TB; a high prevalence of TB was found in patients with psoriasis (18.0%), even after adjusting for age, work, and other characteristics. Latent TB infection was more common in patients with psoriasis (50%) than in those with inflammatory bowel disease (24.2%). Risk of TB reactivation was also influenced by the type of agent used. Several structural and functional differences among biologic drugs could account for differences in risk of granulomatous infection. Different kinetics of currently available tumor necrosis factor (TNF) antagonists, leading to different TNF bioavailability in granulomatous tissue, may explain differences in TB reactivation among patients treated with biologics. One could argue that etanercept should be the first choice of anti-TNF agent in populations at high risk of TB. Risk of TB reactivation during treatment with other biologics is not yet well defined.
针对各种免疫细胞或细胞因子的生物疗法的出现，彻底改变了一些皮肤病，尤其是银屑病的治疗方法。然而，生物疗法可能会影响活动性结核病（TB）的风险。我们回顾了已发表的关于皮肤科使用的生物制剂导致结核病风险再激活的安全性数据。根据最近的研究结果，银屑病本身可能是结核病的一个独立危险因素；即使在对年龄、工作和其他特征进行调整之后，银屑病患者中结核病的患病率仍高达18.0%。潜伏性结核感染在银屑病患者中（50%）比在炎症性肠病患者中（24.2%）更为常见。结核病再激活的风险也受所用制剂类型的影响。生物药物之间的一些结构和功能差异可能导致肉芽肿感染风险的差异。目前可用的肿瘤坏死因子（TNF）拮抗剂的不同动力学，导致肉芽肿组织中TNF生物利用度不同，这可能解释了接受生物制剂治疗的患者中结核病再激活的差异。有人可能会认为，在结核病高风险人群中，依那西普应作为抗TNF药物的首选。使用其他生物制剂治疗期间结核病再激活的风险尚未明确界定。
