Is Chemoprophylaxis Necessary for All Latent Tuberculosis Infection Patients Receiving IL-17 Inhibitors? A Cohort Study.

Shu, Dan; Zhang, Zhuying; Zhou, Eray Yihui; Ma, Xuzhu; Zhao, Yi

BACKGROUND The tuberculosis (TB) burden is high in China, with a 32% prevalence of latent tuberculosis infection (LTBI) in Beijing. Screening for LTBI and the chemoprophylaxis of positive patients are recommended prior to biologic therapy. OBJECTIVE To evaluate the TB-related safety of secukinumab (SEC) in a cohort of plaque psoriasis patients with LTBI receiving different treatments. METHODS Plaque psoriasis patients eligible for SEC treatment were screened for TB. LTBI patients (QuantiFeron-TB test positive, QFT+) receiving SEC were closely monitored by chest radiograph, ESR or hs-CRP, and blood counts every 12-20 weeks for active TB infection. QFT- patients receiving SEC treatment were screened for LTBI every 6-12 months. RESULTS Of 42 patients treated with SEC, 19 were QFT+ (45.24%). A QFT- patient became QFT+ after 6 months treatment. Two patients started SEC treatment from 2015 and 2016 and were followed up 268 and 216 months later, respectively. Three patients received chemoprophylaxis, 17 did not because of safety concerns or being unable to complete the process. During the 16- to 268-week follow-up, no signs of TB reactivation were observed in the 20 LTBI patients receiving SEC. CONCLUSION Plaque psoriasis patients with LTBI who received no chemoprophylaxis could be safely treated with SEC. This article is protected by copyright. All rights reserved.