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Active Tuberculosis in Patients with Psoriasis Receiving Biologic Therapy: A Systematic Review

  • Igor SnastEmail author
  • Einav Bercovici
  • Efrat Solomon-Cohen
  • Tomer Avni
  • Dorit Shitenberg
  • Emmilia Hodak
  • Lev Pavlovsky
SYSTEMATIC REVIEW

Abstract

Background

Biologic therapies pose a risk for opportunistic infections, especially for reactivating latent tuberculosis infection (LTBI).

Objective

The aim was to describe the clinical features and mortality rate of active Mycobacterium tuberculosis (TB) in psoriasis patients receiving biologic therapies.

Methods

A systematic review of PubMed, Google Scholar, ScienceDirect, Cochrane Library, and ClinicalTrials.gov databases was performed. Studies describing active TB in patients with psoriasis receiving biologic therapy from inception to May 31, 2018 were included. Clinical data as well as mortality rates were recorded.

Results

Fifty-one studies were included, evaluating 78 patients with active TB: 11 prospective studies, 13 retrospective, and 27 case reports/series. Most patients (73%) with active TB were male, the mean age was 48 ± 13 years, and 85% were of European or Asian origin. Pre-treatment LTBI screening was negative for 63% of patients. Disease presented in 33% of patients within the first 3 months of treatment, and in 51% within the first 6 months. Most patients (72%) presented with extra-pulmonary TB, and 49% had disseminated disease. The mortality rate was 7%.

Limitations

Limitations of this review are its small sample size and inclusion of case reports.

Conclusions

Some patients develop active TB despite LTBI screening. Clinicians initiating biologic therapy in patients with psoriasis should be aware of the clinical features of active TB in this scenario.

Notes

Acknowledgements

We would like to acknowledge the help of Dr. Debby Mir in writing the manuscript.

Compliance with Ethical Standards

The data have not been previously presented.

Funding

No funding was received for this study.

Conflict of interest

IS, EB, ESC, TA, DS, EH and LP report no conflict of interest.

Supplementary material

40257_2019_432_MOESM1_ESM.pdf (110 kb)
Supplementary material 1 (PDF 110 kb)

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Authors and Affiliations

  1. 1.Department of DermatologyRabin Medical Center, Beilinson HospitalPetah TikvaIsrael
  2. 2.Unit of Infectious DiseasesRabin Medical Center, Beilinson HospitalPetah TikvaIsrael
  3. 3.Pulmonary Institute, Rabin Medical Center, Beilinson HospitalPetah TikvaIsrael
  4. 4.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael

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