Psoriasis, Anti-Tumor Necrosis Factor Therapy, and Tuberculosis: Report of Three Challenging Cases and Literature Review

• Published in: Infectious diseases and therapy Vol. 2; no. 1; pp. 59 - 73
• Main Authors: Solovan, Caius, Chiticariu, Elena
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.06.2013; Springer Nature B.V
• Subjects: Caregivers; Case Series; Infectious Diseases; Internal Medicine; Literature reviews; Medicine; Medicine & Public Health; Meningitis; Patients; Psoriasis; Quality of life; Skin diseases; Tuberculosis; Tuberculosis; Etanercept; Infliximab; Psoriasis; Dermatology; Tumor necrosis factor; Adalimumab; Biologic therapy
• ISSN: 2193-8229; 2193-6382
• DOI: 10.1007/s40121-013-0003-9

Introduction The era of biologic therapies has provided new options for the treatment of chronic plaque psoriasis. However, safety concerns have led to intensive screening and monitoring of patients receiving anti-tumor necrosis factor alpha (anti-TNF-alpha) agents. Methods The authors describe the cases of three patients with moderate to severe psoriasis treated with anti-TNF agents, with challenging diagnostic and treatment aspects regarding tuberculosis (TB) infection, a serious adverse event associated with this type of treatment. The cases are discussed in the context of a comprehensive literature review describing the risk of TB associated with the use of TNF inhibitors. A critical review of the clinical trials that have tested the safety of these agents is also presented. Results One patient, who tested negatively for latent TB infection (LTBI) during screening, developed active TB under adalimumab therapy. For two other patients the diagnosis and management of LTBI in relation to anti-TNF therapy represented a challenge. Although clinical trials involving the use of anti-TNF therapy for psoriasis haven’t demonstrated a high TB incidence, active TB is continuously reported in association with this treatment. Conclusions Findings from clinical practice and the scientific literature indicate that anti-TNF therapies are associated with an increased risk of TB, and close monitoring of patients is needed.