TNF-α inhibitor–induced psoriasis: A decade of experience at the Cleveland Clinic

Mazloom, Sean; Yan, Di; Hu, Jeffery; Ya, Jason; Husni, M. Elaine; Warren, Christine; Fernandez, Anthony P.

doi:10.1016/j.jaad.2018.12.018

Cited by 54 publications

(90 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Compared with psoriatic patients, IBD patients with PP showed a more severe paradoxical effect, in terms of greater number of locations, and frequent scalp lesions. The finding that significant scalp involvement occurred more often in IBD patients is consistent with previous published data [ 25 , 40 , 44 ] and supports the idea that IBD patients may have distinctive genetic/immunologic factors predisposing to scalp PP development.…”

Section: Discussionsupporting

confidence: 91%

“…Our data also show that the time interval between the beginning of adalimumab treatment and the onset of the paradoxical effect was shorter in IBD patients compared with psoriatic patients. The interval time of about nine months observed for IBD patients in our study is comparable to the median latency of 11 months, reported in a previous study on anti-TNF-α induced PP [ 25 ].…”

Section: Discussionsupporting

confidence: 88%

“…Female gender has been associated with higher risk of developing PP, and it may be considered a risk factor for PP. Hormonal or biological drug dosing-based influences may explain this association [ 3 , 19 , 20 , 21 , 22 , 25 ]. In our series, the majority of female IBD patients with PP and comorbidities were affected mainly by comorbidities such as asthma and allergies, thus suggesting a major dysregulation of the immune system in female PP patients.…”

Section: Discussionmentioning

confidence: 99%

“…The time between the onset of PP and the introduction of the treatment can range from a few days to several months [ 3 ]. The most frequently reported clinical presentations of PP are palmoplantar pustular eruption, plaque-type and guttate psoriasis, and nail and scalp involvement have also been described [ 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Paradoxical Psoriasis Induced by Anti-TNFα Treatment: Evaluation of Disease-Specific Clinical and Genetic Markers

Bucalo

Rega

Zangrilli

et al. 2020

IJMS

View full text Add to dashboard Cite

Paradoxical psoriasis (PP) may occur during treatment with anti-tumor necrosis factor-alpha (TNF-α) drugs in various chronic immune-mediated diseases, mainly inflammatory bowel diseases (IBD) and psoriasis. In this study, clinical and genetic characteristics of PP arising in IBD and psoriatic patients were investigated to identify disease-specific markers of the paradoxical effect. A total of 161 IBD and psoriatic patients treated with anti-TNF-α drugs were included in the study. Of these patients, 39 developed PP. All patients were characterized for the main clinical–pathologic characteristics and genotyped for six candidate single nucleotide polymorphisms (SNPs) selected for their possible role in PP susceptibility. In IBD patients, the onset of PP was associated with female sex, presence of comorbidities, and use of adalimumab. IBD patients with PP had a higher frequency of the TNF-α rs1799964 rare allele (p = 0.006) compared with cases without the paradoxical effect, and a lower frequency of the human leucocyte antigen (HLA)-Cw06 rs10484554 rare allele (p = 0.03) compared with psoriatic patients with PP. Overall, these findings point to specific clinical and genetic characteristics of IBD patients with PP and provide data showing that genetic variability may be related to the paradoxical effect of anti-TNF-α drugs with possible implications into clinical practice.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Paradoxical Psoriasis Induced by Anti-TNFα Treatment: Evaluation of Disease-Specific Clinical and Genetic Markers

Bucalo

Rega

Zangrilli

et al. 2020

IJMS

View full text Add to dashboard Cite

show abstract

“…Biologic medications and their effects on the immune system have been shown to have multiple unanticipated effects on the skin. [4][5][6] We are not insinuating that dupilumab was the cause of our patients having developed CTCL, but we do propose that the underlying interplay of dupilumab with the immune system might have accelerated progression of underlying CTCL, resulting in the lymphoma presenting itself clinically and histopathologically. We also must mention that all 3 cases could represent a "true, true, and unrelated" phenomenon.…”

Section: Commentmentioning

confidence: 85%

Long-standing Dermatitis Treated With Dupilumab With Subsequent Progression to Cutaneous T-cell Lymphoma

Hollins¹,

Wirth²,

Fulchiero³

et al. 2020

Cutis

View full text Add to dashboard Cite

This case series discusses 3 patients with long-standing eczematous or psoriasiform dermatitis, demonstrated by multiple biopsies. Following off-label treatment with dupilumab, all 3 patients had clinical expansion of disease, with histopathologic features consistent with cutaneous T-cell lymphoma (CTCL) on subsequent biopsy. We postulate that this expansion likely was secondary to an exacerbation of extant CTCL following exposure to dupilumab. A proposed mechanism of promotion of CTCL is based on the functional increase in IL-13 available for binding at the upregulated IL-13 receptor (IL-13R) α2 site on cells, following blockade of the α1 receptor with dupilumab. This progression merits further investigation.

show abstract

Absolute and Relative Risk of New-Onset Psoriasis Associated With Tumor Necrosis Factor-α Inhibitor Treatment in Patients With Immune-Mediated Inflammatory Diseases

et al. 2022

View full text Add to dashboard Cite

ImportanceTumor necrosis factor-α inhibitor (TNFi)–associated psoriasis is a rare adverse event following TNFi treatment. Data on the risk of developing TNFi-associated psoriasis when treated with TNFi are sparse.ObjectiveTo investigate the associated risk between new-onset psoriasis and TNFi treatment compared with nonbiologic conventional treatment.Design, Setting, and ParticipantsUsing Danish national registries (1995-2018), this cohort study included patients with inflammatory bowel disease (IBD) and/or rheumatoid arthritis (RA) who received either conventional therapy or TNFi treatment. Patients may not have been diagnosed with psoriasis prior to initiation of treatment. Patients were followed up for up to 5 years. Cox regression models with robust variance were used to compare the risk of developing any type of psoriasis, nonpustular psoriasis, and pustular psoriasis. Patients receiving conventional therapy were used as reference. Data analysis was performed from January 1995 to December 2018.ExposuresFor the present study, the term conventional therapy was used for the nonbiological therapy. For biological therapy, a distinction was made between TNFi treatment and non-TNFi biological therapy.Main Outcomes and MeasuresThe outcome of psoriasis was defined as a registered International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code of psoriasis and/or having 2 consecutive prescriptions of topical vitamin D analogues.ResultsThe study included 109 085 patients, of which 62% were female. Median (IQR) age was 50 (34-64) years. Of the included patients, 108 024 received conventional therapy and 20 910 received TNFi treatment. During follow-up, 1471 (1.4%) patients developed any type of psoriasis, of which 1332 developed nonpustular psoriasis, 127 patients developed palmoplantar pustulosis, and 12 patients developed generalized pustulosis. The incidence rates for developing any type of psoriasis per 1000 patient-years were 3.0 (95% CI, 2.9-3.2) for conventional therapy and 7.8 (95% CI, 7.5-8.9) for TNFi. During treatment with TNFi, the hazard ratio was 2.12 (95% CI, 1.87-2.40; P < .001) for developing nonpustular psoriasis and 6.50 (95% CI, 4.60-9.23; P < .001) for pustular psoriasis compared with conventional treatment. Exposure needed for 1 additional patient to be harmed was 241 patient-years for any type of TNFi-associated psoriasis, 342 patient-years for nonpustular psoriasis, and 909 patient-years for pustular psoriasis.Conclusions and RelevanceIn a Danish nationwide cohort of patients with immune-mediated inflammatory diseases treated with TFNi or conventional treatment and no history of psoriasis, in TFNi-treated patients, nonpustular types of psoriasis constituted the most events, whereas pustular types of psoriasis had the highest relative risk. Although the risk of new-onset psoriasis increased for both nonpustular and pustular types of psoriasis in TFNi-treated patients, the absolute risk remained modest at 241 patient-years of exposure need for 1 additional event and an estimated absolute risk difference around 5 per 1000 patient-years, indicating that the approach to treatment of patients in need of TNFi treatment should not change.

show abstract

TNF-α inhibitor–induced psoriasis: A decade of experience at the Cleveland Clinic

Cited by 54 publications

References 32 publications

Paradoxical Psoriasis Induced by Anti-TNFα Treatment: Evaluation of Disease-Specific Clinical and Genetic Markers

Paradoxical Psoriasis Induced by Anti-TNFα Treatment: Evaluation of Disease-Specific Clinical and Genetic Markers

Long-standing Dermatitis Treated With Dupilumab With Subsequent Progression to Cutaneous T-cell Lymphoma

Absolute and Relative Risk of New-Onset Psoriasis Associated With Tumor Necrosis Factor-α Inhibitor Treatment in Patients With Immune-Mediated Inflammatory Diseases

Contact Info

Product

Resources

About