BURHAN ENGİN, TURANA MAMMADOVA, ŞERMİN BÖREKÇİ, BERİL KARA ESEN
Journal of the Turkish Academy of Dermatology - 2023;17(4):97-102
Background: Psoriasis is a chronic inflammatory disease of the skin, and to a lesser extent of the nails and joints, and has recently been recognized as a complex disease with systemic comorbidities. Recent breakthroughs in the treatment of psoriasis have led to significant improvements in the Psoriasis Area and Severity Index response and Dermatology Life Quality Index, but long-term survival and safety remain controversial. Although the risk of biological agents activating latent tuberculosis (TB) is low, it should not be ignored. This is especially important in Turkey where migration traffic is intense due to its geographical location. The aim of this study was to investigate the safety of biological agents in terms of latent TB infection during the initiation and follow-up of treatment in patients with moderate to severe psoriasis. Materials and Methods: This retrospective, cross-sectional, single-center, hospital-based study included patients admitted to our department between 24.08.2017 and 24.12.2021 who were started on biological agents. Results: The study included 187 patients. The mean age was 42.45±12.48 (16-74) years. Patients had a mean disease duration of 12.66 (3-32) years and 88.8% (n=166) were diagnosed with chronic plaque type psoriasis, 10.7% (n=20) with plaque + nail psoriasis, and 0.5% (n=1) patient with palmoplantar type psoriasis. Psoriatic arthritis was present in 17.6% of patients. Adalimumab was used as a biologic agent in 10.7%, ixekizumab in 35.3%, secukinumab in 31.6%, and ustekinumab in 22.5% of the patients. The mean duration of biologic agent use was 36.56 (12-61) months. Among the patients included in the study, 78.6% (n=147) had used methotrexate, 25.1% (n=47) cyclosporine and 15.55% (n=29) acitretin as conventional treatment agents. While the rate of patients with positive QuantiFERON test at baseline was 42.2% (n=79), the rates of those who became positive and negative during follow-up were 5.3% (n=4) and 11.8% (n=9), respectively. In two patients, the QuantiFERON-TB Gold (QFT) first became positive and then became negative again. The rate of patients with positive initial QFT test results was 42.2%, while the rate of patients who became negative during follow-up was 11.8%. There were no active TB cases. Of the 79 patients with positive QFT test results, 27.8% (n=22) had a negative QFT test result over time. Conclusion: It could not be clarified whether this result of patients who became positive during follow-up but whose initial QFT test result was negative was due to false negativity due to previous immunosuppressive conventional treatment or due to the biological agent used. Recently, there are some confusing results regarding the reliability of QFT test results in latent TB infection screening. It should also be taken into account that seroreversion may be due to false QFT test positivity and that negativity during follow-up may be due both to this cause and to decreased QFT test sensitivity in isoniazid treated individuals.
