Tuberculosis risk and drugs in dermatology

Elevated risk of active tuberculosis with interleukin (IL)-17, IL-23, IL-12/23, Janus kinase inhibitors, cyclosporine, and Tumor Necrosis Factor-α inhibitors compared with the general population: A population-based analysis using TriNetX

Cohorts included patients treated for at least one year with TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors, ustekinumab, dupilumab, systemic Janus kinase (JAK) inhibitors, or cyclosporine for any indication (Supplemental Table 1). Minimum exposure time was identified by at least one additional prescription within one to two years of the initial prescription. TB (International Classification of Diseases [ICD]-10 codes A15–A19) diagnosis within one year of initial prescription was the primary outcome. Exclusion criteria were concurrent prescription of another study drug within two years and known latent TB infection (Z22.7), due to difficulty identifying treatment status.
Yearly TB incidence was calculated. Unadjusted (due to query limitations of the built-in TriNetX analysis platform) logistic regressions compared drug-associated TB risk with baseline TB risk (of patients never taking any included drugs). Multivariable Cox proportional hazards models assessed the one-year TB risk of studied drugs compared to TNF-α inhibitors (Table 2) while adjusting for known TB risk factors (Supplemental Table 2).

All drug classes except dupilumab conferred a higher unadjusted rate of TB compared to the baseline population risk.