TOPLINE

In a meta-analysis of dermatologic patients receiving systemic therapy, tuberculosis (TB)-related outcomes varied according to treatment mechanism and regional TB burden, with TNF inhibitors showing the highest risk among biologics.

METHODOLOGY

• Researchers conducted a systematic review and meta-analysis of 31 studies reporting active TB or latent TB infection (LTBI) conversion in 15,005 dermatologic patients (primarily with psoriasis) receiving systemic therapy, published up to October 2025.
• A total of 27 cohort studies, 2 randomized clinical trials, and 2 case-control studies were included.
• Primary outcomes were the incidence of LTBI conversion among patients with negative baseline tuberculin skin test or interferon-gamma release assay results and active TB during follow-up.
• Prespecified subgroup analyses were conducted by biologic class (TNF inhibitors; interleukin [IL]-17 inhibitors; and ustekinumab, an IL-12/23 inhibitor) and regional TB burden (high-burden vs low-burden settings based on World Health Organization classification).

TAKEAWAY

• The pooled incidence of LTBI conversion was 4.3%, and the incidence of active TB was 1.0%.
• Among biologic agents, TNF inhibitors were associated with the highest incidence of LTBI conversion (4.9%), followed by IL-17 inhibitors (2.2%) and ustekinumab (1.8%).
• Conventional immunosuppressive therapies were associated with higher rates of LTBI conversion (9.8%) and active TB (5.9%) than biologic therapies.
• TB incidence was consistently higher in high-burden vs low-burden regions among patients treated with TNF inhibitors (LTBI: 5.5% vs 4.6% and active TB: 1.6% vs 0.8%) and IL-17 inhibitors (LTBI: 3.0% vs 1.4%).

IN PRACTICE

The meta-analysis indicates that “TB-related risk among dermatologic patients receiving systemic therapy is heterogeneous and shaped by treatment category, drug mechanism, and regional TB burden,” the authors of the study wrote. These findings, they added, “advocate for a paradigm shift from universal TB screening toward risk-stratified management tailored to specific therapies and epidemiologic contexts.”

SOURCE

The study was led by Kaixuan Liu, MD, and Ziyi Zeng, MD, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China, and was published online on July 15 in JAMA Dermatology.

LIMITATIONS 

The analyses were based on single-arm incidence. Drug class was analyzed rather than disease type, and data on JAK inhibitors and IL-17 inhibitors were limited.

DISCLOSURES

The authors reported no conflicts of interest disclosures.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.