Development of psoriasis in IBD patients under TNF-antagonist therapy is associated neither with anti-TNF-antagonist antibodies nor trough levels

Protić, Marijana; Schoepfer, Alain; Yawalkar, Nikhil; Vavricka, Stephan R.; Seibold, Frank

doi:10.1080/00365521.2016.1218541

Cited by 22 publications

(28 citation statements)

References 30 publications

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“…Contrary to the trend in older literature, most studies do not report an association with female gender, race, or body mass index (BMI), suggesting a possible reporting bias in previous studies. 8,12,[17][18][19][20][21]…”

Section: Resultsmentioning

confidence: 99%

“…An association with complicated IBD phenotype was found, although this could possibly represent confounding by indication, as patients with more difficult to treat CD (upper GI tract and perianal disease) and UC (pancolitis) are more likely to receive anti-TNF-a therapy. 16,18,20 The same is true for a shorter duration of disease, as this could indicate a more aggressive phenotype, requiring biological therapy. 8…”

Section: Discussionmentioning

confidence: 96%

“…Anti‐TNF‐ α antibodies and anti‐TNF‐ α trough levels were not associated with an increased risk of psoriasiform lesions. Therefore, reducing the infusion dosage or increasing the interval between two infusions probably has no impact on these side effects …”

Section: Discussionmentioning

confidence: 99%

“…30 It has also now been approved for the treatment of Crohn's disease. 31 A class switch to ustekinumab was attempted in some of the included reports, 8,16,18,20,21,23 mostly off-label, with marked improvement of lesions in the majority of cases. Although the applied dosing regimens followed the one recommended for psoriasis, clinical IBD remission was still achieved.…”

Section: Ustekinumab and Other Potential New Therapiesmentioning

confidence: 99%

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Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Melo

Magina

2018

Int J Dermatology

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Tumor necrosis factor alpha inhibitors (anti-TNF-α) completely revolutionized the treatment of inflammatory bowel disease (IBD). However, anti-TNF-α-induced cutaneous side effects have been increasingly reported in the literature. Particularly, psoriasis and the recently recognized psoriasiform lesions are of particular concern, as anti-TNF-α agents are also used in the treatment of psoriasis, seemingly reflecting an immunological paradox. The clinical management of these cutaneous lesions is particularly challenging, owing to the potential need of anti-TNF-α discontinuation and scarcity of other therapeutic options. Therefore, optimization of current topical and systemic therapies and incorporation of new therapeutic agents is of great interest. Our aim is to review data in the literature regarding the clinical management of these cutaneous lesions and provide a therapeutic algorithm, supported by our experience as a tertiary referral center for IBD. Although in older reports no distinction was made, anti-TNF-α-induced psoriasiform lesions are not only more prevalent but also bear notable differences from classical psoriasis, possibly reflecting a different nosological entity. Onset of lesions has been related to periods of IBD remission, as supported by low levels of fecal calprotectin. Psoriasiform lesions can be adequately managed either by topical (glucocorticoids, calcineurin inhibitors, and antibiotics) or systemic (phototherapy, acitretin, glucocorticoids, and antibiotics) therapies and/or switch to other anti-TNF-α agents. Data referring to patients who were able to continue on the same IBD therapy ranged from 30.7 to 100%, reinforcing the importance of an adequate control of these lesions. The recently approved ustekinumab offers another step in the management of anti-TNF-α-intolerant patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Ustekinumab and Other Potential New Therapiesmentioning

confidence: 99%

See 2 more Smart Citations

Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Melo

Magina

2018

Int J Dermatology

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“…Adult data are mixed. Afzali et al reported that patients who developed psoriasis had increased clinical IBD activity, while Protic et al reported little to no IBD activity at time of psoriasis, including no change in inflammatory markers …”

Section: Discussionmentioning

confidence: 99%

Tumor necrosis factor‐α inhibitor‐induced psoriasis in juvenile idiopathic arthritis patients

Groth

Pérez

Treat

et al. 2019

Pediatric Dermatology

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Background/Objectives The development of psoriasis while on tumor necrosis factor inhibitors (TNFi) is a paradoxical effect of agents that treat psoriasis. There is a paucity of data available on this entity in juvenile idiopathic arthritis (JIA). Our objectives were to determine the prevalence of TNFi‐induced psoriasis in patients with JIA at two pediatric centers, and psoriasis response to therapeutic modifications. Methods We performed retrospective chart review on patients with JIA treated with TNFi (adalimumab, etanercept, infliximab) who developed psoriasis. TNFi‐induced psoriasis was defined as an incident diagnosis of psoriasis after starting a TNFi. Patients with personal histories of psoriasis prior to TNFi therapy were excluded. Following diagnosis, responses to medication changes were defined based on physician assessments. Results Nine of 166 (5.4%) patients on TNFi for JIA were diagnosed with TNFi‐induced psoriasis. All cases were female. One had a family history of psoriasis. The median age was 10 (range 2‐16) years. Five (55%) patients experienced scalp psoriasis, including four (44%) with alopecia. Two (22%) patients achieved significant improvement after switching to different classes of biologic agents, while three (33%) patients had significant improvement following discontinuation of biologic therapy. One of five patients who switched to a different TNFi had complete resolution, while four had worsening symptoms or partial improvement. Conclusions Our findings demonstrate the prevalence of TNFi‐induced psoriasis in JIA at two centers. Though larger studies are needed, our data suggest discontinuation of TNFi or biologic class switching should be considered as treatment strategies in select patients.

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Psoriasis Associated With Tumor Necrosis Factor Inhibitors in Children With Inflammatory Diseases

Buckley

Xiao

Perman

et al. 2021

Arthritis Care & Research

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Objective To estimate the incidence rate (IR) of psoriasis in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic noninfectious osteomyelitis (CNO) with tumor necrosis factor inhibitor (TNFi) exposure as compared to children without TNFi exposure and to the general pediatric population. Methods This was a single‐center retrospective cohort study of children with IBD, JIA, or CNO from 2008 to 2018. TNFi exposure was defined as a prescription for adalimumab, etanercept, infliximab, certolizumab, or golimumab, and the primary outcome was incident psoriasis. IRs and standardized incidence ratios (SIRs) were calculated. Cox proportional hazards models were used to assess the association of psoriasis with TNFi exposure and other risk factors. Results Of the 4,111 children who met inclusion criteria, 1,614 (39%) had TNFi exposure and 2,497 (61%) did not, with 4,705 and 6,604 person‐years of follow‐up, respectively. There were 58 cases (IR 12.3 per 1,000 person‐years) and 25 cases (IR 3.8 per 1,000 person‐years) of psoriasis in children with and without TNFi exposure, respectively. The SIR was 18 (95% confidence interval [95% CI] 15–22) overall, 30 (95% CI 23–39) for children with TNFi exposure, and 9.3 (95% CI 6.3–14) for children without TNFi exposure. The hazard ratio of psoriasis comparing TNFi exposure to no TNFi exposure was 3.84 (95% CI 2.28–6.47; P < 0.001). Conclusion Children with IBD, JIA, and CNO had an increased rate of psoriasis compared to the general pediatric population, with the highest rate in those with TNFi exposure.

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Development of psoriasis in IBD patients under TNF-antagonist therapy is associated neither with anti-TNF-antagonist antibodies nor trough levels

Abstract: Anti-TNF-induced psoriasis seems to be independent of anti-TNF antibodies and trough levels. Interruption of Anti-TNF therapy is rarely necessary.

Cited by 22 publications

References 30 publications

Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Clinical management of Anti‐TNF‐alpha‐induced psoriasis or psoriasiform lesions in inflammatory bowel disease patients: a systematic review

Tumor necrosis factor‐α inhibitor‐induced psoriasis in juvenile idiopathic arthritis patients

Psoriasis Associated With Tumor Necrosis Factor Inhibitors in Children With Inflammatory Diseases

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