Patients with immune-mediated inflammatory diseases who receive treatment with a tumor necrosis factor-α inhibitor (TNFi) instead of conventional treatment face a 2-fold higher risk of new-onset psoriasis, according to a recent study.
While noting that providers and their patients should be aware of the potential risk, the researchers of the study underscored that the risk of new-onset psoriasis due to TNFi treatment appears to be rare. The study of 120,000 patients with inflammatory bowel disease (IBD) and/or rheumatoid arthritis (RA) showed that 241 patient-years of TNFi exposure was needed for 1 additional event of TNFi-associated psoriasis.
“To our knowledge, no other study has been able to include this high number of patients and cases with both IBD and RA, exclude patients with established psoriasis, compare patients treated with a TNFi to a relevant group of patients receiving conventional treatment (control group), and complete sensitivity analyses including patients receiving non-TNFi biological therapy,” described the researchers. “This thus allowed the current study to estimate the relative risk and absolute risk of new-onset psoriasis in patients with IBD or RA receiving TNFi treatment with greater certainty than previous attempts as well as assessing the exposure needed for 1 additional event.”
The researchers flagged that the Danish national registries used in their study were unable to differentiate between cases of psoriasis and cases of psoriasis as a direct result of treatment.
Throughout the study, new-onset psoriasis occurred at a rate of 7.8 per 1000 person-years among patients who received a TNFi and at a rate of 3.0 per 1000 person-years among patients who received conventional treatment. Compared with conventional treatment, TNFi was associated with a hazard ratio of 2.38 (95% CI, 2.13-2.68; P < .001).
Among psoriasis subtypes, patients who received treatment with a TNFi were at the highest risk for postular psoriasis, with a hazard ratio of 6.50 (95% CI, 4.60-9.23; P < .001) compared with patients who received conventional treatment. Patients who received a TNFi were also at a higher, albeit less pronounced, risk for nonpustular psoriasis compared with patients who received conventional treatment (HR 2.12; 95% CI: 1.87-2.40; P < .001).
Over the study period, 1.4% (n = 1471) of patients developed psoriasis, the majority of which (n = 1332) developed nonpustular psoriasis. Fewer patients developed palmoplantar pustulosis (n = 127) and generalized pustulosis (n = 12).
“The overall risk of developing any type of new-onset psoriasis was lower for IBD compared with RA (HR, 0.63; 95% CI, 0.54-0.72; P < .001),” found the researchers. “Similar results were found for nonpustular psoriasis but not pustular psoriasis. However, for all types of psoriasis, we found an interaction between TNFi treatment and IBD. Treatment with TNFi in patients with IBD was thus associated with a higher risk of new-onset psoriasis compared with TNFi treatment in patients with RA (HR, 2.07; 95% CI, 1.65-2.60; P < .001).”
Thein D, Egeberg A, Skov L, Loft N. Absolute and relative risk of new-onset psoriasis associated with tumor necrosis factor-α inhibitor treatment in patients with immune-mediated inflammatory diseases: A Danish nationwide cohort study. JAMA Dermatol. Published online June 29, 2022. doi:10.1001/jamadermatol.2022.2360