A recent retrospective study suggests that interleukin-17 (IL-17) and IL-23 inhibitors pose minimal risk of reactivating tuberculosis (TB) in patients with psoriatic disease who have latent TB infection (LTBI).
Dr. Tiago Torres and colleagues from the University of Porto’s Institute of Biomedical Sciences Abel Salazar investigated the impact of IL-17 and IL-23 inhibitors on TB reactivation in patients with psoriasis, given that these medications can suppress the immune system.
LTBI affects approximately one-quarter of the global population, with a 5% to 10% chance of developing active TB if untreated. However, certain medical conditions or therapies that modulate the immune system can elevate the risk of TB reactivation.
The study, conducted across 14 dermatology centers in five countries, focused on adult patients with moderate to severe chronic plaque psoriasis and newly diagnosed LTBI. These patients were treated with IL-23 or IL-17 inhibitors for an average of 32.87 months.
Among the 405 patients analyzed, only one case of TB reactivation occurred after 14 months of treatment with ixekizumab (Taltz, Eli Lilly), an IL-17A inhibitor. The study found that the proportion of active TB associated with ixekizumab was 1.64% (95% CI, 0%-5.43%), with no other agents showing an association with TB reactivation.
Overall, the risk of active TB with IL-17 or IL-23 inhibitors was minimal, at 0.46% (95% CI, 0%-1.06%) and 0%, respectively. Notably, most patients received chemoprophylaxis (62.2%), while some did not complete their prescribed dosage (10.1%) and others did not receive it at all (27.7%).
The findings suggest that for patients with LTBI deemed at high risk of chemoprophylaxis-related complications, this preventive strategy may be waived prior to initiating IL-17 or IL-23 inhibitor treatment.
Furthermore, the researchers recommend prioritizing IL-17 or IL-23 inhibitors over TNF antagonists when concerns arise about TB reactivation in psoriatic disease treatment.
The study underscores the importance of weighing the risks and benefits of specific biologic therapies in patients with psoriasis and LTBI, providing valuable insights for clinical decision-making.
