IL-17/IL-23抑制剂治疗潜伏性结核感染银屑病患者的结核相关结局分析

Analysis of Tuberculosis-Related Outcomes in Psoriasis Patients with Latent Tuberculosis Infection Treated with IL-17/IL-23 Inhibitors

摘要: 背景：近年来，银屑病靶向治疗应用广泛，但潜伏性结核感染(latent tuberculosis infection, LTBI)患者使用非TNF-α靶向药物治疗后潜伏结核再激活情况缺乏真实世界证据，尤其是未接受预防性抗结核治疗的人群中。我们对我科近三年的此类患者进行了回顾性的调查。方法：本研究为单中心回顾性研究，连续纳入2023年1月至2025年1月期间就诊的中重度银屑病患者。所有患者治疗前T-SPOT.TB检测阳性，经排除活动性结核后启动靶向治疗，且在专科评估后未接受预防性抗结核治疗。主要描述对象为接受IL-17或IL-23抑制剂治疗的患者；JAK抑制剂及PDE4抑制剂使用者因样本量有限，仅作描述。随访期间观察活动性结核的发生情况。结果：随访(22 ± 10)个月，未发生潜伏结核再激活。结论：在规范结核筛查及临床随访管理的前提下，本研究所纳入的经风险评估后未接受预防性抗结核治疗的LTBI银屑病患者中，接受IL-17或IL-23抑制剂治疗期间未观察到结核再激活事件。鉴于样本量少及随访时间短，需多中心、大样本、更长时间的观察。

Abstract: Background: In recent years, targeted therapy for psoriasis has been widely applied. However, there is a lack of real-world evidence regarding the reactivation of latent tuberculosis in patients with latent tuberculosis infection (LTBI) after treatment with non-TNF-α targeted drugs, especially among those who have not received preventive anti-tuberculosis treatment. We conducted a retrospective survey of such patients in our department in the past three years. Methods: This study is a single-center retrospective study. Consecutive patients with moderate to severe psoriasis who presented for treatment between January 2023 and January 2025 were included. All patients had positive T-SPOT.TB test results before treatment. After excluding active tuberculosis, targeted therapy was initiated, and they did not receive preventive anti-tuberculosis treatment after specialist evaluation. The main subjects of description were patients treated with IL-17 or IL-23 inhibitors; users of JAK inhibitors and PDE4 inhibitors were only described due to the limited sample size. The occurrence of active tuberculosis was observed during the follow-up period. Results: After a follow-up of (22 ± 10) months, no reactivation of latent tuberculosis was observed. Conclusion: On the premise of standardized tuberculosis screening and clinical follow-up management, no tuberculosis reactivation events were observed during the treatment with IL-17 or IL-23 inhibitors in the LTBI psoriasis patients included in this study who did not receive preventive anti-tuberculosis treatment after risk assessment. Given the small sample size and short follow-up time, multi-center, large-sample, and longer-term observations are required.