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Incidence, Clinical Characteristics, and Management of Psoriasis Induced by Anti-TNF Therapy in Patients with Inflammatory Bowel Disease: A Nationwide Cohort Study

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Guerra, I
  • Perez-Jeldres, T
  • Algaba, A
  • Monfort, D
  • Calvet, X
  • Chaparro, M
  • Manosa, M
  • Minguez, M
  • de Zarate, JO
  • Marquez, L
  • Prieto, V
  • Garcia-Sanchez, V
  • Guardiola, J
  • Rodriguez, GE
  • Martin-Arranz, MD
  • Garcia-Tercero, I
  • Sicilia, B
  • Masedo, A
  • Lorente, R
  • Rivero, M
  • Fernandez-Salazar, L
  • Van Domselaar, M
  • Lopez-SanRoman, A
  • Ber, Y
  • Garcia-Sepulcre, M
  • Ramos, L
  • Bermejo, F
  • Gisbert, JP
  • Spanish GETECCU Grp

Grupos

Abstract

Background: Psoriasis induced by anti-tumor necrosis factor-alpha (TNF) therapy has been described as a paradoxical side effect. Aim: To determine the incidence, clinical characteristics, and management of psoriasis induced by anti-TNF therapy in a large nationwide cohort of inflammatory bowel disease patients. Methods: Patients with inflammatory bowel disease were identified from the Spanish prospectively maintained Estudio Nacional en Enfermedad Inflamatoria Intestinal sobre Determinantes geneticos y Ambientales registry of Grupo Espanol de Trabajo en Enfermedad de Croh y Colitis Ulcerosa. Patients who developed psoriasis by anti-TNF drugs were the cases, whereas patients treated with anti-TNFs without psoriasis were controls. Cox regression analysis was performed to identify predictive factors. Results: Anti-TNF-induced psoriasis was reported in 125 of 7415 patients treated with anti-TNFs (1.7%; 95% CI, 1.4-2). The incidence rate of psoriasis is 0.5% (95% CI, 0.4-0.6) per patient-year. In the multivariate analysis, the female sex (HR 1.9; 95% CI, 1.3-2.9) and being a smoker/former smoker (HR 2.1; 95% CI, 1.4-3.3) were associated with an increased risk of psoriasis. The age at start of anti-TNF therapy, type of inflammatory bowel disease, Montreal Classification, and first anti-TNF drug used were not associated with the risk of psoriasis. Topical steroids were the most frequent treatment (70%), achieving clinical response in 78% of patients. Patients switching to another anti-TNF agent resulted in 60% presenting recurrence of psoriasis. In 45 patients (37%), the anti-TNF therapy had to be definitely withdrawn. Conclusions: The incidence rate of psoriasis induced by anti-TNF therapy is higher in women and in smokers/former smokers. In most patients, skin lesions were controlled with topical steroids. More than half of patients switching to another anti-TNF agent had recurrence of psoriasis. In most patients, the anti-TNF therapy could be maintained.

Datos de la publicación

ISSN/ISSNe:
1078-0998, 1536-4844

INFLAMMATORY BOWEL DISEASES  OXFORD UNIV PRESS INC

Tipo:
Article
Páginas:
894-901
PubMed:
26933750
Factor de Impacto:
1,970 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 67

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Keywords

  • ulcerative colitis; side effects; anti-TNF; Crohn's disease; infliximab; inflammatory bowel disease; adalimumab; psoriasis

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