Ixekizumab, and other antibodies that target interleukin 17 monoclonal antibody (IL-17A), may reduce reactivations of tuberculosis in patients with latent tuberculosis infection (LTBI), according to a study research published in the Journal of the American Academy of Dermatology.

The findings were from a post hoc analysis of integrated safety data from 13 clinical trials of patients with psoriasis (n=5898) and 3 trials of patients with psoriatic arthritis (n=1118). The safety analyses reported treatment-emergent LTBI in patients who were treated with ixekizumab. Assessment of LTBI was made with the purified protein derivative skin test or QuantiFERON-TB Gold assay. Only patients who tested negative for LTBI either at screening or <3 months before baseline were included in the post hoc analysis.

It was noted that 1.7% (n=101) of patients with psoriasis developed treatment-emergent LTBI, and 65 of these patients discontinued ixekizumab. A total of 30 patients who remained in their trial initiated LTBI-specific therapy, whereas the other 6 patients who continued in their trial did not receive therapy.

It was found that 2.9% (n=32) of patients with psoriatic arthritis developed treatment-emergent LTBI, and 7 of the 12 patients who continued ixekizumab also received LTBI therapy. Only 5 patients were not treated with a LTBI-specific therapy. None of the 6 patients with treatment-emergent LTBI without LTBI-specific therapy during ixekizumab experienced reactivation of their disease.

Limitations of the analysis were the lack of a control group, the small number of events, and the short observation time.

The investigators wrote that additional real-world data are needed to address the clinical question on the potential long-term risk for reactivation of tuberculosis under anti-IL 17 therapy.

Disclosure: This clinical trial was supported by Eli Lilly and Company. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors disclosures.

Reference

Mrowietz U, Riedl E, Winkler S, et al. No reactivation of tuberculosis in patients with latent tuberculosis infection receiving ixekizumab: A report from 16 clinical studies of patients with psoriasis or psoriatic arthritis [published online June 8, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.06.012

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Ixekizumab May Prevent Reactivation of Tuberculosis in Patients With Latent Tuberculosis Infection - Dermatology Advisor