Tuberculosis risk and drugs in dermatology
Description
The risk of active tuberculosis diagnosis is lower with interleukin (IL)-17, IL-23, IL-12/23, and Janus kinase inhibitors than with Tumor Necrosis Factor-α inhibitors, but is elevated compared with the population risk. 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. All drug classes had a lower adjusted risk of TB compared with TNF-α inhibitors. Fully adjusted regressions identified diabetes, viral hepatitis, age, and male sex as additional risk factors (Supplemental Tables 3-8).