IL-17, IL-23 inhibitors may not reactivate tuberculosis in patients with psoriasis

Key takeaways:

• Of 405 patients, only one case of tuberculosis reactivated after 14 months of treatment with ixekizumab.
• The association between active tuberculosis and IL-17 or IL-23 inhibitors was 0.46% and 0%, respectively.

Interleukin-17 and IL-23 inhibitors do not increase the risk for tuberculosis reactivation among patients with psoriatic disease who have a latent tuberculosis infection, according to a retrospective study.

“It is estimated that around one-quarter of the world’s population has [latent tuberculosis infection (LTBI)], but only 5% to 10% of individuals with LTBI will develop active tuberculosis infection if left untreated,” Tiago Torres, MD, PhD, professor of dermatology at the Institute of Biomedical Sciences Abel Salazar at the University of Porto, and colleagues wrote. “However, the presence of some medical conditions or therapies that suppress or modulate the immune system may increase the risk of reactivation.”

As psoriasis is frequently treated with IL- 17 and IL-23 inhibitors, which can impair the immune system, researchers may ask themselves if patients treated with these biologics risk reactivating a tuberculosis infection in patients with LTBI. In this study, Torres and his colleagues found that this should not be the case.

According to data from 14 dermatology centers across five countries, adult patients with moderate to severe chronic plaque psoriasis and newly diagnosed LTBI who were treated with IL-23 or IL-17 inhibitors for a mean duration of 32.87 months did not encounter an increased risk for tuberculosis reactivation.

Out of 405 patients analyzed in the study, only one case of tuberculosis reactivated after 14 months of treatment with ixekizumab (Taltz, Eli Lilly), an IL-17A inhibitor. According to the study, the proportion of active tuberculosis associated with ixekizumab was 1.64% (95% CI, 0%-5.43%). For all other agents, the association was 0%.

This means that, overall, the association between active tuberculosis and IL-17 or IL-23 inhibitors was 0.46% (95% CI, 0%-1.06%) and 0%, respectively. The authors did note, however, that a majority of patients did complete a chemoprophylaxis administration (62.2%). On the other hand, some patients did not complete their chemoprophylaxis dosage (10.1%) or simply did not receive one at all (27.7%).

These findings have led the researchers to suggest that if a patient with LTBI is considered high risk for developing complications related to chemoprophylaxis, this preventative strategy can be waived before initiating treatment with IL-17 or IL-23 inhibitors.

Further, the researchers concluded that, “when concerns regarding tuberculosis reactivation exist, IL-17 or IL-23 inhibitors should be preferred over TNF antagonists for the treatment of psoriatic disease.”