TNFi related to a triple higher risk of psoriasis in patients with JIA


Children with juvenile idiopathic arthritis (JIA) have almost three times the risk of developing psoriasis after initiating therapy with tumor necrosis factor (TNF) inhibitors, according to preliminary research shared at the annual meeting of the Alliance for Research in Childhood Arthritis and Rheumatology (CARRA).

Dr. Yongdong (Dan) Zhao

Previous retrospective research at the Children’s Hospital of Philadelphia had found similar results, so the aim of this study was to examine data prospectively collected from the CARRA registry that represented a larger patient population than a single one. institution, main author Yongdong (Dan) Zhao, MD, PhD, said in an interview, assistant professor of rheumatology at the University of Washington, Seattle, and pediatric rheumatologist at Seattle Children’s Hospital.

“The message we bring home is that we have confirmed this finding and everyone who has prescribed it should be aware [of the risk] and also raise awareness in the family because often the family just thinks it’s eczema and they self-manage without informing the doctor, ”Zhao said. He advised doctors to look for psoriasis tests on visits and, depending on the severity, prepared with a management plan if necessary.

The researchers analyzed data from patients with AIA enrolled in the CARRA registry during June 2015 to January 2020. They excluded patients with a diagnosis of inflammatory bowel disease, psoriasis before or before your diagnosis of AIG, or missing data on the time of diagnosis of psoriasis or the start of TNF inhibitors.

Among 8,222 children (29% of whom were men), just over half (54%) had never used TNF inhibitors. The majority of patients (76%) were white and their mean age at the time of JIA diagnosis was 7 years. Compared to those without drug exposure, patients who had been prescribed a TNF inhibitor were three times more likely to be diagnosed with psoriasis later (unadjusted risk ratio). [HR] = 3.01; Pg <.01). The risk decreased only slightly (HR = 2.93; Pg <.01) after adjustment by gender, race, family history of psoriasis, initial classification category of the International League of Associations for Rheumatology and having ever taken methotrexate.

The mean follow-up time of the cohort was 46.7 months. The overall incidence of psoriasis in the cohort was 5.28 cases per 1,000 person-years, which was divided into 3.24 cases for those who were never exposed to TNF inhibitors and 8.49 for those which were never exposed. The incidence was similar (8.31 cases per 1,000 person-years) after the first course of TNF inhibitors.

Dra. Pamela Weiss

TNF inhibitors are a first-line biological treatment for JIA and have a longer history of safety and effectiveness than newer drugs, Zhao said. They are also commonly used in children with psoriasis Pamela Weiss, MD, associate professor of pediatrics and epidemiology at the University of Pennsylvania, Philadelphia, and director of rheumatology clinical research at Philadelphia Children’s Hospital. He did not participate in the study.

“TNF inhibitors are a class of drugs that are incredibly useful for children with arthritis, including psoriatic arthritis“Weiss said in an interview.” I don’t think these findings affect the risk-benefit profile of TNF inhibitors, as paradoxical psoriasis is a known side effect of medication and is something most of us already advise our families and patients before starting a. TNF inhibitor drug “.

Zhao also did not think that the results changed the benefit-risk profile of these drugs as long as people are aware of them. If the psoriasis is mild, he said, it is often possible to continue therapy with TNF inhibitors along with a topical medication for psoriasis, “but if it is really severe or by patient preference, you may need to switch to a TNF inhibitor. different or stop it, ”he said. Occasionally, he has added an additional biological product to treat psoriasis, as the underlying JIA disease in the patient could not be controlled without the TNF inhibitor.

Similarly, Weiss said management will depend on the severity and shared decision-making between the doctor, the patient and the family.

“If it’s a small area, it can often be controlled with topical corticosteroids,” Weiss said. “If it affects a large area of ​​the body or severely affects the scalp, you could consider stopping therapy with TNF inhibitors and starting another therapy directed at a different pathway.”

The research was funded by CARRA. Zhao has received funding for the Bristol-Myers Squibb research and has consulted for Novartis. Weiss has received consulting fees from Pfizer and Lilly.

This article originally appeared on, which is part of the Medscape professional network.

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