Incidence of and Risk Factors for Paradoxical Psoriasis or Psoriasiform Lesions in Inflammatory Bowel Disease Patients Receiving Anti-TNF Therapy Original paper

What was studied?

The systematic review and meta-analysis focused on the incidence and risk factors associated with paradoxical psoriasis or psoriasiform lesions in patients with inflammatory bowel disease (IBD) who were treated with anti-tumor necrosis factor (anti-TNF) therapy. Anti-TNF therapies, such as infliximab, adalimumab, and certolizumab, have been widely used in the treatment of IBD, including Crohn’s disease (CD) and ulcerative colitis (UC). However, a paradoxical phenomenon has been observed where these therapies, which are also used to treat psoriasis, can induce psoriasis or psoriasiform skin lesions in some patients. This review aimed to quantify the pooled incidence of these skin lesions and identify the demographic and clinical risk factors that might contribute to their development.

Who was studied?

The study included a total of 30 articles comprising 24,547 IBD patients who were treated with anti-TNF agents. The studies were selected based on strict inclusion criteria, including observational cohort studies or case-control studies published in English, with full-text access. The patients included in the studies were diagnosed with IBD, either CD or UC, and had received anti-TNF therapy. The data focused on the incidence of psoriasis and psoriasiform lesions, with additional information on potential risk factors such as age, gender, smoking status, and the specific type of anti-TNF therapy used. These studies were conducted across a range of geographic locations, including Europe, North America, and Asia, offering insights into the global prevalence of anti-TNF-induced psoriasis in IBD patients.

Most important findings

The pooled incidence of psoriasis and/or psoriasiform lesions following anti-TNF therapy in IBD patients was 6.0%, with significant heterogeneity observed across studies. The incidence was higher for psoriasiform lesions compared to psoriasis. Meta-regression analysis identified several significant risk factors associated with the development of psoriasis or psoriasiform lesions. Female patients, younger age at the initiation of anti-TNF therapy, smoking status, and specific anti-TNF agents (adalimumab and certolizumab) were all found to be associated with an increased risk of developing these skin lesions. Additionally, ileocolonic Crohn’s disease patients showed a higher risk compared to other IBD phenotypes. The study also found variations in risk depending on geographical region and population, suggesting that factors like environmental exposure and genetic predispositions might play a role in these outcomes.

Key implications

The findings from this study have several clinical implications. First, clinicians should be aware of the potential for paradoxical psoriasis or psoriasiform lesions when prescribing anti-TNF therapy for IBD, particularly for patients who are female, younger, or smokers. These patients may require closer monitoring for dermatological side effects. Moreover, the study suggests that the use of adalimumab or certolizumab might carry a higher risk of skin complications compared to infliximab, which may influence treatment decisions. The identification of these risk factors allows for more personalized approaches to IBD treatment, enabling clinicians to make more informed decisions regarding the use of anti-TNF therapies and the management of potential side effects. Understanding the mechanisms underlying these skin reactions could also lead to better preventive strategies or the development of therapies aimed at mitigating these adverse effects. Given the increasing use of anti-TNF therapies, further research is needed to explore the molecular mechanisms behind the paradoxical skin reactions and to identify additional risk factors.