6% of placebo-treated patient 12 SAEs were reported in selleck chemicals infliximab-treated patients Yes Reich et al. [39] Infliximab 5 mg/kg at W0, 2, 6, 14, 22 46 301 0 80 6 Yes Menter et al. [40] Infliximab (i) 3 mg/kg at W0, 2, 6 (ii) 5 mg/kg at W0, 2, 6 50 627 2 70.3–75.5% of infliximab-treated TPCA-1 patients achieved PASI75 after 10 weeks vs. 1.9% of placebo-treated

patients 12 of 627 infliximab-treated patients experienced SAEs vs. 5 of 207 placebo-treated patients Yes Yang et al. [41] Infliximab 26 84 3 81% of infliximab-treated patients achieved PASI75 after 10 weeks vs. 2.2% of placebo-treated patients 4 of 84 infliximab-treated patients experienced SAEs vs. 1 of 45 placebo-treated patients Yes AEs adverse events, PASI75 75% improvement in the Psoriasis Area and Severity Index, SAEs serious adverse events, TB tuberculosis, anti-TNF anti-tumor necrosis factor, W week, eow every other week Although clinical trials have demonstrated significant efficacy and a low number of TB cases in patients with psoriasis, questions remain about BTK animal study the long-term use of these agents. There are several limitations that make it difficult to assess the potential for anti-TNF therapy to promote TB infection. For example, the median time to TB diagnosis has been reported to range from 5.5 to 18.5 months [20], and these randomized, controlled studies extend to a limited period of time (3–13 months).

From another point of view, the study of Yang et al. [41] highlights that TB is a major problem in endemic areas. Furthermore, clinical practice continues to provide Tau-protein kinase details concerning

the increasing numbers of patients with active TB, despite the screening methods for detecting LTBI [42–47]. TB often presents as extrapulmonary or disseminated disease in such patients and has been reported with the use of all of the anti-TNF agents [15, 18, 21, 48–51]. This form of presentation is explained by the underlying mechanism: the immunosuppression induced by anti-TNF therapy leads to reactivation of secondary foci and dissemination of M. tuberculosis [52]. The monoclonal antibodies form stable complexes with all forms of TNF-alpha, including TNF on the surface of macrophages and T cells, which induces T cell and macrophage apoptosis [53, 54]. In addition, biologic therapy inhibits the Th1 cell response, as well as the production of IFN, a cytokine with major roles in the immune defense against M. tuberculosis [55, 56]. Thus, these actions disturb granuloma integrity and increase the risk of secondary foci reactivation [52]. Active TB associated with biologic treatment is believed to be the result of LTBI reactivation in most cases. LTBI is defined as a complex clinical condition in which an infection with M. tuberculosis persists in a subclinical status with minimal replication. The bacilli are unable to cause clinical manifestations and cannot be identified in culture [57].