LTBI IL-17

Risk of Tuberculosis Reactivation During IL-17 Inhibitor Therapy for Psoriasis

Journal of the European Academy of Dermatology and Venereology: JEADV

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• The authors reviewed the literature on latent tuberculosis infection (LTBI) reactivation in psoriasis patients while on IL-17 inhibitors. At 1 year, there was no evidence of reactivation in any of the patients taking secukinumab. In a post hoc analysis of 5730 patients exposed to ixekizumab, 188 had a positive tuberculosis test with a documented history of completing TB treatments. Of these, 4 patients had a positive TB test after approximately 1 to 2 years of ixekizumab, although no cases of active TB were reported. In the one study of brodalumab available, no patients developed active TB.

• This systematic review found no cases of reactivated TB while on IL-17 inhibitors. Secukinumab and ixekizumab had the most clinical trials which permitted inclusion of patients with LTBI, compared with brodalumab, for which additional safety data are warranted. This systematic review supports the use of IL-17 inhibitors in patients with LTBI.

– Margaret Hammond, MD

Abstract

Immunosuppressive therapies, effective in treating inflammatory disorders such as psoriasis, increase the risk of serious infections, such as tuberculosis (TB). For example, tumour necrosis factor (TNF)-alpha inhibitors significantly increase the risk of TB reactivation in patients with latent TB infection (LTBI), which has led clinicians to routinely test for TB prior to initiation of these medications. This protocol has since extended to other, newer immunomodulatory therapies for psoriasis, such as interleukin (IL)-17 inhibitors, including secukinumab, ixekizumab and brodalumab. We conducted a systematic review to examine whether there is any evidence that IL-17 inhibitor therapy for psoriasis increases the risk of TB reactivation. Using PubMed and EMBASE, our literature search resulted in 139 total articles. After manually reviewing each article for the discussion of IL-17 inhibitors for psoriasis, with data originating from clinical trials, and assessment for incidence of TB reactivation, 23 articles met the full inclusion criteria for our review. Overall, we found no cases of TB reactivation in patients treated with IL-17 inhibitors for psoriasis. This suggests that IL-17 inhibitors may be safely used in psoriasis patients with LTBI who receive appropriate LTBI treatment. However, long-term real-world studies are warranted to further evaluate this risk.

Journal of the European Academy of Dermatology and Venereology: JEADV

Risk of Tuberculosis Reactivation During Interleukin-17 Inhibitor Therapy for Psoriasis: A Systematic Review

J Eur Acad Dermatol Venereol 2020 Feb 03;[EPub Ahead of Print], E Fowler, RI Ghamrawi, N Ghiam, W Liao, JJ Wu