Exposure to TNF inhibitors increases psoriasis risk in children with IBD, JIA
TNF-alpha inhibiting therapies are a cornerstone of treatment for inflammatory conditions but have been increasingly implicated in the development of psoriasis.
The single-center study of electronic health record data from 2008 to 2018 included 4,403 children under 19 years at diagnosis, each with at least two ICD-9 or ICD-10 codes for JIA, IBD or chronic noninfectious osteomyelitis and at least two visits with a study center rheumatologist or gastroenterologist.
Researchers defined TNF inhibitor exposure as at least one prescription for Humira (adalimumab, AbbVie), Enbrel (etanercept, Amgen) or Remicade (infliximab, Janssen), and patients were categorized as “ever” or “never” having TNF inhibitor exposure. The cohort was compared with the expected number of psoriasis cases in the general pediatric population, based on previously published data.
Among the cohort, 1,738 children (39%) had TNF inhibitor exposure and 2,665 (61%) did not, which included 5,245 person-years and 7,365 person-years of follow-up, respectively.
There were 64 cases of psoriasis (IR = 1.2 per 100 person-years) in children with TNF inhibitor exposure and 26 cases of psoriasis (IR = 0.4 per 100 person-years) in those not exposed.
The standardized incidence ratio was 17.5 for the entire cohort (95% CI, 14.2-21.5), 29.9 for the TNF inhibitor group (95% CI, 23.4-38.2) and 8.7 for the unexposed group (95% CI, 5.9-12.7), according to the abstract.
In comparing the TNF inhibitor exposure to those not exposed, the HR for psoriasis was 4.23 (95% CI, 2.56-7.01) when all other covariates were held constant.
Furthermore, those who were exposed to a TNF inhibitor and also had a family history of psoriasis had an independently associated increased HR of psoriasis (HR = 3.09; 95% CI, 1.82-5.22).