Biologic Treatment, Smoking May Increase Psoriasis Risk in Patients With IBD

Patients with inflammatory bowel disease (IBD) treated with adalimumab had greater risk of developing psoriasis than those administered infliximab, with gender and smoking incidence also linked with greater IBD risk.

Patients with inflammatory bowel disease (IBD) treated with adalimumab may be at greater risk of developing psoriasis than those given infliximab, according to study findings published in Medicine.

When treating IBD, comprising patients with ulcerative colitis and Crohn disease, tumor necrosis factor-C (TNF-α) antagonists have proven to be effective for patients. However, researchers note that several drug-induced adverse effects have emerged regarding the use of these biologic agents, including greater risk of psoriasis development.

“Psoriasis is attributed to a complex mechanism between the immune system, psoriasis auto-antigens, inflammatory cytokines, and multiple environmental factors,” explained the researchers. “TNF-α is considered the vital factor in the inflammatory reaction by regulating the inflammatory signal transduction pathway.”

Investigating use of the 2 most extensively employed TNF-α antagonists, infliximab and adalimumab, they sought to determine whether risk of psoriasis development in patients with IBD may differ based on the type of biological therapy given.

The researchers conducted a meta-analysis of 12 studies published between 2010 and 2018 from the PubMed, Embase, Web of Science, Google, and Geenmedical databases. Data on study participants included information regarding use of either adalimumab or infliximab, smoking history, and gender.

In the meta-analysis, patients were given infliximab (the experimental group) or adalimumab (the observation group). “The interval of medication was over 1 year, and the interval of medication applying infliximab was longer than that of the adalimumab group,” they noted.

Overall, 692 participants developed psoriasis induced by TNF-α antagonists, 137 patients stopped or switched to biologic agents, and over 50% had a good prognosis.

When comparing the incidence of psoriasis among both drugs, patients with IBD treated with infliximab were 35% less likely to develop psoriasis than those administered adalimumab (odds ratio [OR], 0.658; 95% CI, 0.252-0.905; P < .05).

Moreover, patients with IBD treated with TNF-α antagonists were found to be at significantly greater risk of developing psoriasis if they were female vs male (OR, 1.941, 95% CI, 1.326-2.843; P < .05) and if they reported incidence of smoking (OR, 1.679; 95% CI, 1.237-2.279; P < .05).

Most reported cases of psoriasis were said to be relieved by using local hormone, phototherapy, or systemic hormone therapy under the strategy of biological agents.

“The incidence of psoriasis induced by TNF-α antagonists is higher than other autoimmune diseases, and infliximab treatment for IBD is safer than ADA,” concluded the researchers. “Differences exist in various TNF-α antagonists, and the therapeutic strategy of TNF antagonists is not required to be changed in the event of psoriasis.”


Yang M, Liu W, Deng Q, Liang Z, Wang Q. The incidence of psoriasis among smokers and/or former smokers inflammatory bowel diseases patients treated with tumor necrosis factor antagonist. Medicine (Baltimore). Published online October 22, 2021. doi:10.1097/MD.0000000000027510

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