- Thein D, et al. Risk of anti-TNF-induced psoriasis in patients with immune‐mediated inflammatory diseases – a Danish nationwide cohort study. P27, Psoriasis from Gene to Clinic 2021, 9–11 December.
Some patients with immune-mediated inflammatory disease, such as those with inflammatory bowel disease (IBD) or rheumatic arthritis (RA), develop psoriasis when treated with TNFα inhibitors. As this paradoxical side effect is poorly understood, a Danish cohort study explored the risk of new-onset psoriasis during treatment with a TNF inhibitor compared with the risk during treatment with non-biologic conventional treatment1.
Dr David Thein (Copenhagen University Hospital Gentofte, Denmark) and colleagues evaluated the risk of developing any type of psoriasis, non-pustular, and pustular psoriasis. Data was derived from the Danish national registries, which includes all patients with IBD and/or RA who received either conventional therapy or TNF inhibitor treatment between 1995 and 2018. The analysis included 20,910 patients treated with TNF inhibitors, 108,024 patients treated conventionally, and 4,909 patients treated with non-TNF inhibitor biologics. During the follow-up period, 1,471 (1.4%) patients developed any type of psoriasis.
Most patients (n=1,332) suffered from non-pustular psoriasis, another 127 from psoriasis pustulosis palmoplantaris, and 12 from generalised pustular psoriasis. The relative risk of developing non-pustular psoriasis during treatment with a TNF inhibitor was 2.12 times higher than conventional treatment. An even higher risk of TNF inhibitor intake was associated with developing pustular psoriasis (hazard ratio 6.5). When the risk of TNF inhibitor use was compared with the risk of non-TNF biologics, TNF inhibitor use was associated with an HR of 1.85 for non-pustular and 3.11 for pustular psoriasis.
Based on this data, the researchers calculated that exposure to TNF inhibitors for 241 patient-years is needed for 1 additional patient with any type of TNF inhibitor-induced psoriasis. Although non-pustular types for psoriasis constitute the most events, pustular types of psoriasis had the highest relative risk. The researchers emphasised that practitioners who treat patients with immune-mediated inflammatory disease should be aware of the risk of TNF inhibitor-induced psoriasis.