New Tuberculosis Infection and Reactivation of Tuberculosis in Patients with Psoriasis or Psoriatic Arthritis Receiving IL-23 Inhibitors: A Systematic Literature Review

Biologic agents, including the interleukin-23 (IL-23) inhibitors (IL-23is) guselkumab, risankizumab, and tildrakizumab, are effective therapies for the treatment of psoriasis (PsO) and psoriatic arthritis (PsA). However, the risk of latent TB infection (LTBI) reactivation or new tuberculosis (TB) infection is of question, given documented evidence of occurrence of cases in patients with PsO and PsA treated with biologics with other mechanisms of action, and the relatively high prevalence of TB in some Asian Pacific (APAC) countries. We conducted a systematic literature review to summarize published evidence related to reactivation of LTBI or new TB infections among IL-23i-treated patients with PsO or PsA, with a focus on the APAC region. We searched the EMBASE, MEDLINE, MEDLINE In-Process, CNKI, Wanfang, ICHUSHI, KOREAMED, and AIRITI databases and gray literature sources for reports on randomized controlled trials and real-world observational studies reporting reactivation of LTBI or new TB infections among IL-23i-treated patients with PsO or PsA. A total of 58 publications from 41 studies met prespecified inclusion criteria, including 9 publications from 8 studies in APAC countries. No LTBI reactivation events or new TB cases were observed in 33 of 34 studies that enrolled IL-23i-treated patients with PsO, including patients with LTBI who did not complete chemoprophylaxis. In one observational study, LTBI reactivation was reported in a single risankizumab-treated patient. Similarly, no cases of LTBI reactivation or new TB cases were observed in 8 studies enrolling IL-23i-treated patients with PsA. The results summarized here suggest that the risks of new TB infections or LTBI reactivation are minimal among IL-23i-treated patients with PsO or PsA. Routine testing for LTBI in patients initiating IL-23i treatment should not be required, particularly in regions with low TB prevalence.