TNF inhibitors pose ‘modest risk’ for new-onset psoriasis

Patients with immune mediated diseases and treated with tumor necrosis factor-alpha inhibitors have a modest risk for new onset psoriasis, according to a study.

“Biologics are in most cases effective, and the majority of adverse effects are mild and easy to manage. Paradoxically, psoriasis develops in a number of patients during tumor necrosis factor-alpha inhibition (TNFi) treatment,” David Thein, MB, of the department of dermatology at the University of Copenhagen and Copenhagen Research Group for Inflammatory Skin, and colleagues wrote.

A cohort study of 109,085 patients with inflammatory bowel disease and/or rheumatoid arthritis was conducted using Danish national registries. Subjects with no prior diagnosis of psoriasis were included. Of these 106,765 (98%) received conventional therapies, while 20,387 (19%) received TNFi.

New onset psoriasis was recorded in 1,471 (1.4%) of patients during follow up, with 91% developing non-pustular psoriasis and 9% developing pustular psoriasis. Of those with pustular psoriasis, 91% developed palmoplantar pustulosis and 9% developing generalized pustulosis.

Incidence rates for new-onset psoriasis per 1,000 patient years were 3 (95% CI, 2.9-3.2) for those on conventional therapy and 7.8 (95% CI, 7.5-8.9) for those on TNFi.

The hazard ratio of developing any type of new-onset psoriasis was 2.38 (95% CI, 2.13-2.68) for those receiving TNFi compared with those on conventional therapies.

“In this cohort study, treatment with TNFi in patients with [inflammatory bowel disease or rheumatoid arthritis] was associated with a twofold increased risk of new-onset psoriasis compared with conventional therapy,” the authors wrote. “Nevertheless, new-onset psoriasis due to TNFi treatment was a rare adverse event. ... Practitioners and patients should be aware and observant of the potential for TNFi-associated psoriasis during TNFi treatment but keep in mind that the absolute risk appears to be low.”