Chest Infections: Tuberculosis |

TB Risk in Patients With Biological Therapy for Psoriasis FREE TO VIEW

Ariadna Fildan, MD; Claudia Toma, MD; Doina Tofolean, MD; Oana Arghir, MD; Elena Dantes, MD
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Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):201A. doi:10.1016/j.chest.2016.08.210
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SESSION TITLE: Tuberculosis

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Psoriasis is a chronic inflammatory disease predominantly affecting the skin and joints, with a negative impact on quality of life. Biological agents are highly effective for treating patients with moderate and severe forms of the disease. This therapy is associated with increased risk of developing active tuberculosis (TB). The purpose of this study is the assessment of active TB developed during biological treatment among patients with psoriasis.

METHODS: From 333 patients diagnosed with chronic immune-mediated inflammatory disease referred for evaluation of TB status, 119 patients had psoriasis . Medical history, clinical exam, chest x-ray, tuberculin skin test (TST) and/or INF-γ release assays (IGRA), and sputum examinations for Mycobacterium tuberculosis (MTB) were performed. Cases with TST ≥5 mm or positive IGRA received isoniazid 5 mg/body weight for 9 months. After starting biological treatment, all patients were monitored every 6 months or reinvestigated whenever they become symptomatic.

RESULTS: From the 119 patients with psoriasis (mean age 48.2 years, 72 men and 47 women), 67 were diagnosed with latent tuberculosis infection (56.3%). Average diameter of TST induration was 15 mm. Three cases developed active pulmonary TB: one miliary, one extensive cavitary TB, and one pseudotumoral TB form. Active TB occurred after a mean duration of biological treatment of 8 months. Two TB patients were on infliximab and one on adalimumab. All of them received standard regimen of anti-TB treatment based on Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol for 6 months, with a good clinical outcome.

CONCLUSIONS: Patients with psoriasis receiving biologic therapy should be continously surveilled for developing active TB disease, given the severe, diseminated or atypical forms occured in these cases.

CLINICAL IMPLICATIONS: Active diagnosis of latent or active TB is mandatory in patients receiving biological treatment for immune-mediated inflammatory diseases, such as psoriasis.

DISCLOSURE: The following authors have nothing to disclose: Ariadna Fildan, Claudia Toma, Doina Tofolean, Oana Arghir, Elena Dantes

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