Detection and management of latent tuberculosis infections before biologic therapy for psoriasis.
The biologic agents can be highly efficacious in the treatment of psoriasis and psoriatic arthritis; however, their use is associated with an increased risk of developing active TB. In particular, TNF-α plays critical role in preventing TB infection and reactivation of latent TB infection (LTBI). Therefore, it is critical that all patients be screened for LTBI prior to initiating therapy. An expert panel of Italian dermatologists met recently with the goal of producing a consensus paper on screening and chemoprophylaxis for LTBI in Italian psoriasis patients treated with biologics. Current recommendations for the screening algorithm include medical history, chest x-ray, and tests that evaluate immunologic response to the presence of Mycobacterium tuberculosis. Patients with positive screening results and without active disease are to be treated with a full course of chemoprophylaxis; however, if the patient is compliant and tolerating the regimen, biologic therapy for psoriasis may be started after at least 1 month on prophylactic therapy when prompt control of disease is required.
Dept of Oncology and Neuroscience, Dermatologic Clinic, University G.D'Annunzio, Chieti, Italy.
Paolo
P
Amerio
Giuseppe
G
Amoruso
Federico
F
Bardazzi
Anna
A
Campanati
Nicoletta
N
Cassano
Andrea
A
Conti
Paolo
P
Gisondi
Claudio
C
Guarneri
Annamaria
A
Mazzotta
Stefano
S
Piaserico
Francesca
F
Prestinari
Francesca
F
Prignano
Cristina
C
Zane
Clara
C
de Simone
D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D000068582:Certolizumab Pegol; D003879:Dermatologic Agents / Q000627:therapeutic use*; D000068800:Etanercept; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000175:diagnosis* / Q000188:drug therapy*; D009169:Mycobacterium tuberculosis / Q000502:physiology; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011565:Psoriasis / Q000188:drug therapy*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D014374:Tuberculin Test; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003879:Dermatologic Agents; D007140:Immunoglobulin Fab Fragments; D007074:Immunoglobulin G; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D000068582:Certolizumab Pegol