Frequency of tuberculosis in psoriasis patients using anti-TNF therapy during 16 years of follow-up

Introduction:
Psoriasis is a chronic multi-systemic inflammatory disease. Anti-tumor necrosis factor (TNF) agents such as adalimumab, infliximab, etanercept are effectively used for treatment. The increased risk of infection, especially tuberculosis is a major concern for patients receiving TNF inhibitor therapy.

Aim:
The aim of this study was to evaluate frequency and risk of tuberculosis in psoriasis patients using anti-TNF therapy over a 16-year period.

Material and methods:
This study is based on data from the Turkish Psoriasis Registry (PSR-TR) and digital records of the Medical School of the Bezmialem Vakif University. Patients with tuberculosis were recorded and the details of the treatment they received were explored.

Results:
We detected 3 patients with pulmonary tuberculosis and 1 patient with tuberculosis peritonitis in spite of isoniazid chemoprophylaxis. The common feature of these patients was a history of etanercept treatment.

Conclusions:
We concluded that psoriasis patients receiving TNF inhibitor therapy are at risk of tuberculosis infection despite isoniazid prophylaxis and contrary to the literature it looks like those patients treated with etanercept may be at greater risk for tuberculosis than patients treated with other TNF inhibitor agents.