Rates of latent tuberculosis infection in patients treated with TNF inhibitors for psoriasis: a retrospective chart review.

BACKGROUND

Although tuberculosis screening guidelines for psoriasis patients on TNF inhibitors exist, few studies have reported the prevalence of latent tuberculosis infection (LTBI) and conversion rates in this population.

OBJECTIVE

To determine the incidence of LTBI and active tuberculosis in patients with psoriasis receiving TNF inhibitor therapy.

METHODS

A total of 138 patients were included in our retrospective study of patients treated from September 2004 to September 2017. Tuberculin skin test was considered positive with an induration of greater than 5 mm. History of Bacillus Calmette-Guérin vaccination, follow-up tests and prophylaxis were recorded.

RESULTS

Among 99 biologic-naïve patients, 14 had LTBI before starting biologic therapy and five developed LTBI during TNF inhibitor therapy. One biologic-naïve patient developed LTBI, then active tuberculosis. Among 39 non-biologic-naïve patients, three had LTBI before starting any biologic therapy, and one developed LTBI during treatment.

LIMITATIONS

Limitations include small sample size and limited information documented in the medical chart.

CONCLUSIONS

LTBI appears to be prevalent among psoriasis patients. Screening for LTBI in patients on biologics may reduce risk of active tuberculosis; however, current methods may not be fully effective. Clinicians may need to use other tools including risk factor assessment to fully evaluate risk.