Preventive tuberculosis (TB) therapy before initiating MTX or IL-17/IL-23/IL-12/23p40 inhibitors for latent tuberculosis infection (LTBI) is supported by indirect evidence of TB reactivations with TNF inhibitors. However, direct evidence for MTX or IL-17/IL-23/IL-12/23p40 inhibitors is limited. To better evaluate the risk of TB reactivation, data on LTBI patients exposed to these medications without preventive TB therapy are necessary. This study was conducted as part of the update of the European and German psoriasis guidelines aimed to assess current LTBI screening and preventive treatment practices.
Patients and methods
An online survey was distributed via German, European and international dermatological societies, yielding 326 complete responses.
Results
LTBI screening was performed by 45% of respondents before MTX initiation and 95% before IL-17/IL-23/IL-12/23p40 inhibitors. Preventive TB therapy was initiated "always" or "almost always" in 38% of MTX cases and "never" or "almost never" in 31%. For IL-17/IL-23/IL-12/23p40 inhibitors, preventive TB therapy was used in 66% of cases "always" or "almost always," 16% case-by-case and 9% "never" or "almost never."
Conclusions
LTBI screening and preventive TB therapy for MTX lack standardization. While screening is common for IL-17/IL-23/IL-12/23p40 inhibitors, a significant proportion of LTBI patients receive these treatments without preventive TB therapy.
