Tuberculosis screening guidelines should be updated and quantiferon test should be a prerequisite prior to the initiation of treatment of psoriasis with biological agents

F. Tamer, A. Gulekon

Department of Dermatology, Gazi University School of Medicine, Ankara, Turkey. fundatmr@yahoo.com

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• Dermatology
• Respiratory Medicine

OBJECTIVE: With the current study, we aimed at evaluating the quantiferon test results of psoriasis patients treated with biological agents.

PATIENTS AND METHODS: Between April 2019 and June 2021, medical records of patients with psoriasis who were evaluated for latent tuberculosis infection before the initiation of biological agent treatment were reviewed retrospectively.

RESULTS: This study included 132 patients, 50 (37.9%) female and 82 (62.1%) male. The mean disease duration was 16.42±10.99 years (range: 1-49 years). None of the patients had a previous history of tuberculosis. Quantiferon test was negative in 109 (82.6%) patients and positive in 23 (17.4%) patients. Patients with positive quantiferon test results were older than those who had negative quantiferon test results; the mean ages were 50.21±10.79 and 42.98±11.81 years, respectively (p=0.006).

CONCLUSIONS: Within this study, 17.4% of patients with psoriasis had positive quantiferon test results. We suggest that quantiferon test should be performed in all patients with psoriasis especially in the elderly for latent tuberculosis screening before the initiation of biological agent treatment. Moreover, we suggest that psoriasis treatment guidelines with biological agents should include detailed information on the necessity of chest radiograph, choosing tuberculin skin test or interferon gamma release assays such as quantiferon and T-spot test. In addition, controversies on the requirement of screening for latent tuberculosis and prophylactic tuberculosis treatment before the initiation of novel biological agents such as IL-17 and IL-23 inhibitors should be clarified. An international consensus on the duration of latent tuberculosis treatment and the interval between tuberculosis prophylaxis and the initiation of biological agents should be achieved.

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