A Propensity Score-Matched Study on the Changes of TB Status and TB-IGRA Values in Patients with Psoriasis with Latent TB Receiving Secukinumab

IntroductionThe utilization of biologics in patients with psoriasis with latent tuberculosis infection (LTBI) has garnered significant attention. Although the tuberculosis (TB) safety profile of second-generation biologics, including secukinumab, has been partially confirmed in both clinical trials and real-world studies, the necessity for prophylactic therapy in patients with LTBI prior to administering this class of biologics remains a topic of controversy.MethodsThis study enrolled 62 patients with psoriasis with LTBI who underwent secukinumab with routine TB reexamination. Patients were divided into two groups based on whether they received antituberculosis therapy (ATB; n = 48) or not (NTB; n = 16). We performed a propensity score-matched (PSM) analysis between ATB and NTB subgroups and retrospectively reviewed their interferon-gamma release assays (IGRA) and radiographic results.ResultsNo active TB case was reported on the basis of medical records and chest radiographs in either two group. Before PSM, the mean reexamining IGRA value was significantly elevated in patients who received prophylactic therapy (P = 0.00), but no significant increase was observed in patients who were not. After PSM, there was no significant IGRA value enhancement whether or not patients received prophylactic treatment.ConclusionOur data provide additional information on the safety profile of secukinumab in patients with psoriasis with LTBI. Furthermore, our presentation of the reexamined IGRA results revealed no significant elevation in the ATB or NTB group. As such, we believe further exploration is necessary to determine whether anti-TB medication is required prior to administering secukinumab. In the past decade, biologics have revolutionized psoriasis treatment. Among patients receiving biologics, tuberculosis infection is a big concern. Secukinumab, an interleukin-17 inhibitor, belongs to the second-generation biologics. Clinical trials and real-life experience have partially reported its tuberculosis safety. In 2020, a systematic review of randomized clinical trials of secukinumab found no reactivate tuberculosis case. However, when participants tested positive for latent tuberculosis infection at screening in the clinical trials, they received antituberculosis treatment. Should patients with latent tuberculosis infection receive antituberculosis medication before receiving secukinumab? The answer is controversial and lacks evidence. This study enrolled patients with psoriasis with latent tuberculosis infection who underwent secukinumab with routine tuberculosis reexamination. Then, the patients were divided into two groups based on whether they received antituberculosis therapy and not. We observed that neither of these two groups presented tuberculosis activation cases. We also matched patients who received antituberculosis therapy and those who did not. The interferon-gamma release assay showed no significant increase after balancing the baseline. Our data indicated that secukinumab is safe among patients with latent tuberculosis infection even when they did not receive antituberculosis treatment.

Automated summary

This study investigated the safety of using secukinumab in patients with psoriasis with latent tuberculosis infection (LTBI). The results showed no activation of tuberculosis in either group, regardless of whether patients received antituberculosis therapy. The interferon-gamma release assay also did not show a significant increase after balancing the baseline. Therefore, this study indicates that secukinumab is safe in patients with LTBI, even without antituberculosis treatment.