Expert Panel Recommends Updated TB Screening Approach for Patients With Psoriasis on Targeted Therapies

A recent literature review and expert consensus statement led by the SPIN-FRT group called for a reassessment of tuberculosis (TB) screening and preventive treatment protocols in patients with psoriasis receiving biologic therapies.

The findings, published in Journal of the European Academy of Dermatology and Venereology, highlight the need to distinguish risk profiles based on the specific mechanism of action of the therapeutic agent, rather than applying uniform recommendations across all drug classes.

Tumor necrosis factor (TNF) inhibitors, long recognized for their immunosuppressive properties, are known to significantly increase the risk of TB reactivation. As a result, international guidelines have required screening for latent TB and initiation of prophylactic treatment before starting anti-TNF therapy. These precautionary guidelines have since been extended to newer biologics, including IL-12/23, IL-17, IL-23, and TYK2 inhibitors.

However, a review of existing evidence—spanning randomized controlled trials and real-world data—revealed a notable difference in TB risk across these therapeutic categories.

According to the authors, “The low number of identified cases of reactivation with IL-17 and IL-23 inhibitors prompts reconsidering the need for preventive treatment for latent TB in all cases.”

The panel emphasized that the mechanisms of IL-17 and IL-23 inhibitors differ fundamentally from TNF blockers and may not pose the same risk for latent TB reactivation. As such, a tailored approach to screening and prevention is warranted.

“Current evidence suggests that some of these agents are arguably not associated with an increased risk of TB reactivation,” the study stated, challenging the one-size-fits-all guidance currently in place.

The expert recommendations advise against automatic initiation of TB prophylaxis in all patients treated with newer biologics, especially when the risk of TB reactivation is low and the patient is at increased risk of drug-related toxicity. Instead, the decision to treat latent TB should be informed by both the patient’s risk profile and the specific therapeutic mechanism.

For dermatologists managing moderate-to-severe psoriasis, this guidance supports a shift toward more individualized decision-making. As new agents continue to reshape the treatment landscape, the authors concluded, “these recommendations highlight the need for updates to the existing guidelines,” ensuring they align with emerging data and drug safety profiles.

Clinicians are encouraged to integrate these evolving insights into routine practice, particularly when initiating treatment in patients with a history of TB exposure or in regions where TB is endemic.

Reference
Torres T, Brembilla NC, Langley RG, et al. Treatment of psoriasis with biologic and non-biologic targeted therapies in patients with latent tuberculosis infection or at risk for tuberculosis disease progression: recommendations from a SPIN-FRT expert consensus. J Eur Acad Dermatol Venereol. 2025;39(1):52-69. doi:10.1111/jdv.20287