J Am Acad Dermatol. 2026 Nov 2:S0190-9622(26)03840-5. doi: 10.1016/j.jaad.2026.10.085. Online ahead of print.
ABSTRACT
BACKGROUND: The NPF/IPC statement exempts routine tuberculosis (TB) testing for IL-17/IL-23 inhibitors in low-burden settings, but elimination may be unsafe in high-burden regions.
OBJECTIVE: To develop and evaluate a clinical score estimating the probability of a high pretreatment interferon-γ release assay (IGRA) response in psoriasis patients before biologic therapy in China.
METHODS: Adult patients with psoriasis scheduled to initiate biologic therapy who underwent pretreatment screening were retrospectively included from four Chinese hospitals. Logistic regression was used to develop and evaluate the score.
RESULTS: The psoriasis TB risk score (PTRS) comprised six items: age>43.0 years (1), BMI>24.8 kg/m2 (2), married status (1), smoking (2), alcohol consumption (3), and acitretin use (-2). The AUC was 0.799 (95% CI, 0.758-0.840) in the development cohort, 0.697 (0.625-0.768) in validation cohort 1, and 0.621 (0.462-0.780) in the exploratory Shenzhen cohort. Positivity rates in the development, validation, and external validation cohorts were 2.4%/8.8%/33.2%, 3.7%/11.8%/20.8%, and 2.9%/8.8%/13.7% for the low-, intermediate-, and high-risk groups, respectively.
LIMITATIONS: Retrospective design without longitudinal TB outcomes; performance declined in the geographically distinct cohort.
CONCLUSIONS: The PTRS stratified the probability of a high pretreatment IGRA response in Chinese cohorts; local validation is required before the score is used to modify testing practice.
PMID:42971476 | DOI:10.1016/j.jaad.2026.10.085