Daily PubMed evidence board
New Tuberculosis Infection and Reactivation of Tuberculosis in Patients with Psoriasis or Psoriatic Arthritis Receiving IL-23 Inhibitors: A Systematic Literature Review
This systematic literature review looked at whether drugs that block interleukin-23 (guselkumab, risankizumab, and tildrakizumab) - used to treat psoriasi…
Signal score52Research triage score
CertaintyModerateVerify in full text
PMID42262459Source identifier
Research triage, not medical advice
Do not use this summary, score, or benefit-cost estimate to diagnose, treat, prescribe, or change care without reviewing the full study and consulting qualified professionals.
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Check full-text methods, eligibility, outcomes, risk of bias, harms, conflicts, funding, replication, and applicability.
Plain-English signal
This systematic literature review looked at whether drugs that block interleukin-23 (guselkumab, risankizumab, and tildrakizumab) - used to treat psoriasis and psoriatic arthritis - are linked to new tuberculosis infections or reactivation of latent TB. The authors searched multiple databases and gray literature and included 58 publications from 41 studies (including 9 publications from 8 studies in the Asia-Pacific). In most studies (33 of 34 that enrolled patients with psoriasis) no new TB infections or reactivation of latent TB were reported, even among some patients who did not complete LTBI chemoprophylaxis. One observational study reported LTBI reactivation in a single risankizumab-treated patient. No TB events were reported in the studies of patients with psoriatic arthritis. The authors conclude the risks appear minimal and suggest routine LTBI testing before IL-23 inhibitor treatment may not be required in low-TB-prevalence regions. This summary is based on the abstract; the full paper should be checked for detailed methods and counts.
Why it matters
- Addresses risk of latent tuberculosis infection (LTBI) reactivation or new tuberculosis (TB) infection among patients with psoriasis (PsO) or psoriatic arthritis (PsA) treated with IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab).
- Directly relevant to clinical and public-health guidance on baseline LTBI screening and management for patients starting IL-23 inhibitors, especially in regions with higher TB prevalence such as parts of the Asia-Pacific (APAC).
- Findings could affect recommendations on infection screening, prophylaxis policies, and safety monitoring for an expanding class of biologic therapies used in dermatology and rheumatology.
Primary outcomes
- Reactivation of latent tuberculosis infection (LTBI)
- New tuberculosis (TB) infection
Effect summary
Abstract-reported finding: Across 58 publications from 41 studies (including APAC studies), no LTBI reactivation events or new TB cases were observed in 33 of 34 PsO studies; one observational study reported a single LTBI reactivation with risankizumab. No events were observed in 8 PsA studies. Authors conclude risks are minimal and routine LTBI testing may not be required in low-prevalence regions.
Benefit-cost lens
| Quick take | Systematic review of trials and observational studies found minimal observed LTBI reactivation or new TB cases among IL-23 inhibitor-treated patients with PsO or PsA; further full-text and contextual cost-data are needed before changing screening policy. |
|---|---|
| BCR anchor | 2 |
| Time horizon | 3 |
| Discount rate | 0.03 |
| Assumptions | Summary and triage based only on PubMed metadata and abstract; assumes abstract accurately reports event counts and that included studies are representative of intended populations; full-text review required to confirm denominators, follow-up duration, and heterogeneity. |
Benefit-cost fields are assumptions-based unless explicitly source-derived. Treat them as prompts for deeper economic review.
Risk of bias
| Tool | rapid-abstract-screen |
|---|---|
| Verdict | Some concerns |
| Notes | Assessment based solely on PubMed metadata and abstract. No access to full-text methods, inclusion/exclusion criteria, event denominators, follow-up durations, or study-level bias assessments. Systematic review design is higher-level evidence but validity depends on search completeness, study quality, and pooling decisions reported only in full text. |
Harms, equity, conflicts & implementation
| Implementation | Before policy or practice changes: obtain full-text review, extract absolute event counts and person-time, assess study quality and applicability to local populations, model costs of screening vs. non-screening, and consult infectious disease and TB-control experts. |
|---|---|
| Equity impact | Unclear from abstract; potential equity implications if TB prevalence, access to screening, or biologic availability differ across subpopulations or regions - full-text subgroup data needed. |
| Harms | No new TB cases or LTBI reactivations reported in most included studies per abstract; harms reporting in included studies and potential rare events require full-text confirmation. |
| Replication | Unknown from abstract-only screening; underlying study data and reproducibility not assessed. |
Source links — verify original
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