medwireNews: Treatment with tumor necrosis factor inhibitors (TNFi) is associated with a twofold increased risk for new-onset psoriasis compared with nonbiologic agents, suggest findings from a Danish cohort study.
However, the absolute risk “remains modest,” indicating that “[p]ractitioners and patients should be aware and observant of the potential for TNFi-associated psoriasis,” but “ought not change their initial approach to treatment,” say the researchers in JAMA Dermatology.
The study included 109,085 patients with rheumatoid arthritis (RA; 49%) or inflammatory bowel disease (51%) from national registries in Denmark who were treated with biologic or nonbiologic therapy in 1995–2018.
In all, 1.4% of these people developed new-onset psoriasis, of whom 91.0% developed nonpustular psoriasis and 9.0% pustular psoriasis. The median follow-up duration was 1.3 years for patients with nonpustular psoriasis, 1.2 years for those with pustular psoriasis, and 3.1 years for those who did not develop psoriasis.
David Thein (University of Copenhagen, Denmark) and team found that the 20,387 patients taking TNFi had a significant 2.38-fold higher risk for new-onset psoriasis than the 106,765 patients on nonbiologic treatments, with incidence rates of 7.8 versus 3.0 per 1000 person–years.
The researchers note that although nonpustular psoriasis was the most prevalent type, pustular psoriasis “constituted the highest risk in relative terms,” with TNFi conferring a 6.50-fold increased risk for pustular and a 2.12-fold increased risk for nonpustular psoriasis relative to nonbiologic treatment.
They say that the exposure needed for one additional patient to develop an event was 241 person–years for any type of TNFi-associated psoriasis, 342 person–years for nonpustular psoriasis, and 909 person–years for pustular psoriasis.
The team considered the possibility that the increased risk for new-onset psoriasis during TNFi treatment could explained by the “the increased disease burden found in patients receiving biological therapy.” However, in a sensitivity analysis comparing TNFi with other biologic agents, the risk for new-onset psoriasis remained significantly elevated in the TNFi group, with a 1.98-fold increased risk overall.
“This finding indicates that new-onset psoriasis in patients receiving TNFi treatment is not associated with disease severity and supports the notion that risk is likely associated with TNFi,” write Thein et al.
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