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Dr. Steven Ang, Dr. Leo Kah Woon, 11 Jul 2018
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Anti-TNF agents may contribute to increased risk of psoriasiform diseases in IBD

04 Jul 2018

Use of antitumour necrosis factor (anti-TNF) agents in patients with inflammatory bowel disease (IBD) appears to be associated with an increased likelihood of developing psoriasiform diseases, with the risk of palmoplantar pustulosis most pronounced in males and younger patients, according to a study.

Drawing data from the Korea National Health Insurance Claim Data, researchers looked at 5,428 IBD patients treated with any anti‐TNF agent for >6 months (anti‐TNF group) and 10,856 matched controls who had never taken anti‐TNF agents (control group).

Psoriasis occurred with significantly greater frequency in the anti‐TNF vs control group (36.8 vs 14.5 per 10,000 person‐years). Use of anti-TNF was associated with a more than twofold increase in the risk of developing psoriasis (hazard ratio [HR], 2.357; 95 percent CI, 1.668–3.331).

Moreover, the anti-TNF group had greater risks of palmoplantar pustulosis (HR, 9.355; 2.754–31.780) and psoriatic arthritis (HR, 2.926; 1.640–5.218).

When analyses were stratified according to IBD subtypes, anti-TNF agent use was associated with a heightened risk of psoriasis in both Crohn’s disease (HR, 2.549; 1.658–3.920) and ulcerative colitis (HR, 2.105; 1.155–3.836).

Of note, the risk of palmoplantar pustulosis was markedly higher in subgroups of male (HR, 19.682; 3.867–100.169) and younger (aged 10–39 years; HR, 14.318; 2.915–70.315) patients exposed to anti-TNF agents.

The present data underscore the need for evaluating paradoxical psoriasiform diseases carefully when prescribing or considering anti‐TNF agents for IBD patients, as researchers pointed out. More studies are warranted to characterize the predictive factors for this phenomenon.

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