Evaluation of serial Quantiferon-TB gold in tube test results and tuberculosis infection status in patients with psoriasis receiving anti IL-17 treatment (secukinumab and ixekizumab): a real world data from a tuberculosis endemic country

In comparison with TNF-α inhibitors, anti-IL-17A agents are considered to have a lower risk of active tuberculosis (TB) or latent TB infection (LTBI) reactivation. It is controversial whether serial LTBI screening is cost-effective and really necessary for biologic therapies other than TNF-α inhibitors. In this study, we aimed to evaluate the TB infection status and serial Quantiferon-TB-Gold in tube test (QFT) test results of psoriasis patients using IL-17 inhibitors (secukinumab [SEC] and ixekizumab [IXE]) in a real-world setting from a tuberculosis endemic country. Patients with psoriasis who used IL-17 inhibitors (SEC or IXE) for at least 3 months in our follow-up were included in the study. From the past medical records, patients' clinical and demographic features, baseline QFT test result, latest QFT test result (if any), TB infection status were noted. A total of 717 patients, of whom 333 (46.4%) were female, were included in the study. The mean age was 47.15 ± 14.6 years. The cumulative exposure time to an anti IL-17 agent was 14147 patient-months, 9743 patient-months for SEC and 4404 patient-months for IXE. 459 (SEC=305/IXE=154) patients used anti IL-17 agent for ≥12 months. Of these, 125 had a positive baseline QFT result. 334 had negative baseline QFT results. The latest QFT result of 309 was also negative (persistent seronegative group). During follow-up, the QFT results of 10 patients changed from negative to positive (positive seroconversion group). 7 of them were using SEC, 3 of them were using IXE. No case of active TB infection was detected. Anti-IL-17 agents are safe in terms of TB infection risk profile. The need for serial QFT monitoring and TB prophylaxis for anti-IL-17 therapies may be re-evaluated.