Latent TB converts in 1 in 23 patients on dermatological systemic therapy

The edition in brief

A systematic review of 31 studies and 15,005 patients on systemic therapy for immune-mediated skin disease found pooled latent tuberculosis conversion of 4.3% among patients who screened negative at baseline, highest with TNF inhibitors, then IL-17 inhibitors and ustekinumab. Active tuberculosis occurred in 1.0% overall and more often in high-burden regions - which is the figure that matters most in India, where baseline screening is routine but repeat screening during treatment often is not. Separately, the Dutch BioDay registry followed 309 children under 17 on dupilumab for moderate to severe atopic dermatitis for up to three years. Disease control was maintained, with mean EASI 3.4 (95% CI 2.4 to 4.5) and itch score 3.6 at three years, and three-year drug survival was 80.1%. Dupilumab-associated ocular surface disease was reported in 36.6%. Children aged 6 months to 5 years reported more itch and worse quality of life throughout and stopped more often for administration problems. In chronic kidney disease-associated pruritus, NIKAIA-1 randomised 258 haemodialysis patients to nemolizumab 30 mg, 60 mg or placebo for 12 weeks; the primary endpoint of a 4-point or greater fall in worst itch was not met (60 mg 47.7%, P = 0.069; 30 mg 38.5%; placebo 32.4%), though the week-4 separation was wide. The FDA has posted an ongoing Class II recall of Lupin's clobetasol propionate cream 0.05% in 60 g tubes for failing content uniformity specifications.