Dermatology Clinic, Department of Medical Sciences, Turin, Italy.
Unit of Infectious Diseases, Amedeo di Savoia Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.
Acta Derm Venereol. 2022 Nov 29;102:adv00821. doi: 10.2340/actadv.v102.1982.
Psoriatic patients with latent tuberculosis infection and properly treated active tuberculosis need careful management when prescribing modern biological drugs. Although data and guidelines regarding tumour necrosis factor-α inhibitors advise caution and initiation of prophylactic therapy in patients with latent tuberculosis infection, the same indications do not seem to find equal force for interleukin (IL)-23 and IL-17 inhibitors. In order to evaluate the risk of reactivation in patients with latent tuberculosis infection or properly treated active tuberculosis, an observational retrospective study was conducted on the population referred to our centre at Dermatologic Clinic of University of Turin, Italy. In the last 10 years at the clinic 19 psoriatic patients were found to be at risk of tuberculosis reactivation: 10 patients were QuantiFERON- TB-positive at baseline, 2 became positive during treatment, 6 reported prior tuberculous infection, and 1 was QuantiFERON-TB-negative at baseline and developed disseminated tuberculosis during treatment with anti-tumour necrosis factor-α. Overall, 10.5% of this group of patients developed active tuberculosis; however, stratifying by biologic therapy, zero cases were observed among patients treated with anti-IL-17, -23, or -12/23 over a relatively long follow-up (48.1 months) A review of the available literature following our experience confirms the increased risk of tuberculosis reactivation with tumour necrosis factor-α inhibitors. Concerning anti-IL-23 and IL-17 drugs, available data showed high safety in patients at risk of tuberculosis reactivation. Screening of patients who should be taking IL-17 and IL-23 inhibitors is recommended for public health purposes. In case of a positive result with these therapies, consulting with an infectious diseases specialist is suggested in order to weigh up the risks and benefits of prophylactic treatment.
患有潜伏性结核感染和活动性结核病的银屑病患者在开具现代生物药物时需要谨慎管理。尽管关于肿瘤坏死因子-α抑制剂的数据和指南建议在潜伏性结核感染患者中谨慎使用并启动预防性治疗，但对于白细胞介素 (IL)-23 和 IL-17 抑制剂，似乎并没有同等的指示。为了评估潜伏性结核感染或已治疗的活动性结核病患者的复发风险，对意大利都灵大学皮肤科诊所转介至我们中心的人群进行了一项观察性回顾性研究。在该诊所的过去 10 年中，发现 19 名银屑病患者有结核病复发的风险：10 名患者基线时 QuantiFERON-TB 阳性，2 名在治疗期间转为阳性，6 名报告有既往结核感染，1 名基线时 QuantiFERON-TB 阴性，在接受抗肿瘤坏死因子-α治疗期间发展为播散性结核病。总的来说，该组患者中有 10.5%发生了活动性结核病；然而，按生物治疗分层，在接受抗 IL-17、-23 或 -12/23 治疗的患者中，在相对较长的随访期（48.1 个月）内未观察到病例。根据我们的经验，对现有文献的回顾证实了肿瘤坏死因子-α抑制剂结核再激活的风险增加。关于抗 IL-23 和 IL-17 药物，现有数据显示在有结核再激活风险的患者中具有较高的安全性。建议出于公共卫生目的对应接受 IL-17 和 IL-23 抑制剂治疗的患者进行筛查。如果这些治疗方法的结果为阳性，建议咨询传染病专家，权衡预防性治疗的风险和益处。
Zotero 插件