Patients receiving TNFi for rheumatoid arthritis more likely to develop psoriasis
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Key takeaways:
- An analysis of more than 880,000 post-marketing reports found that all TNF inhibitors demonstrate a statistically significant association with psoriasis, compared with methotrexate.
- Certolizumab pegol had an especially high reported risk for psoriasis, compared with all other RA monotherapy groups.
Patients with rheumatoid arthritis who receive TNF inhibitors are more likely to develop psoriasis vs. those treated with methotrexate, according to an analysis of more than 880,000 post-marketing reports published in Scientific Reports.
“This set of records enables us to compare the impact of different drugs for the same indication and, more importantly, reveal new, or previously unknown or poorly characterized, adverse effects and quantify them using rigorous statistical methods,” Ruben Abagyan, PhD, of the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California, San Diego, told Healio.
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“We simply noticed that strange but statistically significant ‘signal’ of psoriasis when we looked at the side effect reports related to the rheumatoid arthritis treatments, and decided to look into that further, compare different treatments, and rule out possible biases,” he added.
To investigate potential links between TNF inhibitors for RA and the development of psoriasis, Abagyan and colleagues analyzed data from the FDA Adverse Event Reporting System. The researchers identified records that included RA as the sole indication for therapy and mentioned psoriatic-related disease as an adverse event, limiting themselves to data created by physicians, pharmacists and other health care professionals. Drugs found in the reports were standardized to generic equivalents where necessary, and data were standardized from all reports.
Terms that indicated psoriasis for the purposes of this study included erythrodermic psoriasis, guttate psoriasis, nail psoriasis, dermatitis psoriasiform, pustular psoriasis and psoriasis. Therapies included in the analysis were certolizumab pegol, adalimumab (Humira, AbbVie), golimumab (Simponi, Janssen), tocilizumab (Actemra, Genentech), abatacept (Orencia, Bristol Myers Squibb), infliximab (Remicade, Janssen), rituximab (Rituxan, Genentech), etanercept (Enbrel, Amgen), tofacitinib (Xeljanz, Pfizer) and methotrexate. Patients treated with methotrexate were used as a control group.
In all, the researchers assessed more than 880,000 post-marketing safety reports of patients treated for RA. Compared with methotrexate monotherapy, “all TNF inhibitors” carried a statistically significant association with psoriasis, Abagyan and colleagues wrote. The reporting OR (ROR) for developing psoriasis in patients who received certolizumab pegol was particularly high, at 16.94 (95% CI, 7.86-36.5). The likelihood was also elevated, compared with methotrexate, for adalimumab (ROR = 10.29; 95% CI, 4.79-22.12), golimumab (ROR = 6.09; 95% CI, 2.57-14.42), infliximab (ROR = 4.56; 95% CI, 1.99-10.41) and etanercept (ROR= 2.55; 95% CI,1.91-8.49).
Severa non-TNF inhibitor therapies were also associated with an increased risk for psoriasis. This was true of tocilizumab (ROR = 5.31; 95% CI, 2.32-12.12), abatacept (ROR = 4.63; 95% CI, 2.07-10.34), rituximab (ROR = 3.83; 95% CI, 1.48 – 9.88) and tofacitinib (ROR = 1.97; 95% CI, 0.85-4.58), according to the researchers.
“The main takeaway for rheumatologist is to be aware of a statistically significant association of several common RA treatments, including certolizumab pegol, adalimumab, golimumab and infliximab, and, to a smaller extent, etanercept,” Abagyan said. “The second message is that it appears from the data that certolizumab pegol has the strongest association.”
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