medwireNews: Exposure to tumor necrosis factor (TNF) inhibitors is associated with a threefold increased risk for developing psoriasis in children with juvenile idiopathic arthritis (JIA), US study findings indicate.
“Increasing awareness of this unwanted side effect in JIA patients is important to ensure timely diagnosis and treatment,” write Yongdong Zhao (Seattle Children’s Research Institute, Washington) and co-authors in the Annals of the Rheumatic Diseases.
They add, however, that “[c]oncurrent methotrexate use could be considered to ameliorate the risk.”
During a median 3.9 years of follow-up, 223 cases of psoriasis were reported among 8225 individuals with JIA who were members of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, which covers 70 sites in North America. Of these, 84 (37.7%) cases had never been exposed to a TNF inhibitor and 139 (62.3%) had current or prior exposure.
Just over half (53.9%) of participants in the overall cohort had ever used a TNF inhibitor, most commonly etanercept (34.3%), followed by adalimumab (30.6%) and infliximab (7.2%).
After adjustment for methotrexate exposure, sex, race, family history of psoriasis, and JIA diagnosis category, the researchers found that the hazard ratio (HR) for new-onset psoriasis after any exposure to a TNF inhibitor was a significant 2.93 relative to no exposure.
Furthermore, the results were similar when TNF inhibitor exposure was categorized as current use and first use only, which suggests “that the risk is not altered by the duration of TNF [inhibitor] treatment and the incidence of psoriasis will continue to occur as patients remain on the treatment,” Zhao et al remark.
The researchers also analyzed the data by JIA category and found that the HR for psoriasis with any TNF inhibitor use versus no use was a significant 5.60 for individuals with non-psoriatic JIA compared with 1.68 among those with psoriatic JIA.
Conversely, the team found that the risk for psoriasis among participants with non-psoriatic JIA who were concurrently using methotrexate was significantly lower than those not using methotrexate, at a HR of 0.45. The risk with concurrent methotrexate use was also lower among the group with psoriatic JIA, but not significantly so (HR=0.73).
These findings suggest that there is “potential benefit of combining methotrexate with TNF [inhibitors] to prevent new onset of psoriasis,” say the investigators.
Of note, psoriasis development was not associated with race or ethnicity or with a family history or psoriasis.
Zhao and colleagues conclude that a longitudinal study among patients who have stopped TNF inhibitor use is needed “to determine the continuing risk after discontinuation of TNF [inhibition].”
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Ann Rheum Dis 2022; doi:10.1136/annrheumdis-2021-221694