Wednesday, 16 Oct 2019

You are here

TNF Inhibitor Induced Psoriasis

Tumor necrosis factor-α inhibitors (TNFi) rarely have been reported to induce new-onset psoriasis. Although the rate of this adverse event is estimated to be 1/1000, it occurs with all TNFi and occurs in rheumatoid arthritis (RA), inflammatory bowel disease (IBD) and even psoriasis patients receiving TNF inhibitors.

A systematic review of published cases of TNF-α inhibitor-induced psoriasis identified 88 articles with 216 cases of new-onset TNF-α inhibitor-induced psoriasis.

The mean age at psoriasis onset was 38.5 years. The most commonly affected were Crohn disease (40.7%) and rheumatoid arthritis (37.0%). Onset of TNFi-induced psoriasis occurred after an average of 14.0 months of TNFi therapy, with 70% noting onset within the first year.  

Affected patients were primarily taking infliximab (62.5%) or adalimumab (21.8%) and few were treated with etanercept (14.4%).

Skin presentations were mixed in 26.9% of patients The most common presentations included plaque (44.8%), palmoplantar pustular (36.3%) psoriasism and psoriasiform dermatitis (19.9%), severe scalp involvement (7.5%), and generalized pustular psoriasis (10.9%). The lesions were equally distributed on the soles, extremities, palms, scalp, and trunk.  Histopathology revealed primarily plaque psoriasis (54.9%) and pustular psoriasis (33.3%).

Although topical therapy was used in most, the most effective regimens were: 1) 47.7% TNFi discontinuation lead to resolution or improveent in 94%; 2)  36.7% switched TNFi inhibitors and nearly 55% improved or resolved; and 3) 32.9% continued therapy with 33% resolved and 57% improving their psoriasis.

Mechanisms underlying this adverse event are not well understood.

The authors suggest that skin-directed therapies works n many cases does and that cessation of TNFi treatment will be needed in a minority of patients.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

One-Third of Psoriatic Arthritis Patients Will Need Joint Surgery

Dannish study has shown that one-third of psoriatic arthritis (PsA) will have joint surgery that that PsA patients have twice the rate of joint surgery when compared with the general population.

The Danish National Patient Registry was used in this cohort study of incident PsA patients and their future risk of joint surgery compared to a general population cohort (GPC) between 1995-2012).

FUTURE 5 - Secukinumab and Less Radiographic Progression in Psoriatic Arthritis

The FUTURE 5 trial studied the effect of secukinumab (SEC) on radiographic progression through 52 weeks in patients with active psoriatic arthritis (PsA) and found that SEC was clinically and radiographically superior to placebo (PBO). Patients received s.c. secukinumab 300 mg load (300 mg), 150 mg load (150 mg), 150 mg no load regimens or placebo at baseline, at weeks 1, 2 and 3 and every 4 weeks starting at week 4. The majority (87%) of patients enrolled at baseline remained in the study for 52 weeks.

Ixekizumab vs. Adalimumab in Psoriatic Arthritis

The Annals of Rheumatic Disease reports a psoriatic arthritis study where in ixekizumab was non-inferior to adalimumab for achievement of ACR50 responses but was superior to adalimumab for achievement of PASI100 by week 24.

NSAID Use Linked With Hypertension in Ankylosing Spondylitis

Continuous use of nonsteroidal anti-inflammatory drugs (NSAIDs) among patients with ankylosing spondylitis (AS) was associated with the development of incident hypertension, a prospective cohort study found.

Anti-IL-23 Beats IL-17 in Plaque Psoriasis

Lancet reports a head-to-head trial of antibodies against interleukin (IL)-23 and IL-17A in patients with moderate-to-severe psoriasis favored guselkumab with superior PASI 90 responses at week 48 (compared to secukinumab).