TNF-α Inhibitor-Induced psoriasis: A decade of experience at the Cleveland Clinic

TNF-α inhibitor-induced psoriasis: A decade of experience at the Cleveland Clinic

Background: TNF-α inhibitor-induced psoriasis (TNFi-psoriasis) remains poorly understood despite being described 15 years ago. As TNF-α inhibitors (TNFis) often provide life-changing patient benefits, understanding effective treatments for TNFi-psoriasis is important.

Objective: We characterized a cohort of TNFi-psoriasis patients specifically diagnosed and (co)managed by dermatologists at a single tertiary care institution over a ten-year period.

Methods: Retrospective review of patients diagnosed with TNFi-psoriasis between 2003-2013.

Results: 102 patients with TNFi-psoriasis were identified. Mean age of onset was 40 years, and there was a female predominance(73.5%). Crohn's disease(48%) and rheumatoid arthritis(24.5%) were the most common primary conditions. Infliximab(52%) was the most common inciting agent. The most common TNFi-psoriasis subtypes were plaque-type(49.5%), scalp(47.5%), and palmoplantar pustulosis(41%). Topical medications alone improved/resolved TNFi-psoriasis in 63.5% patients, and cyclosporine and methotrexate (>10mg weekly) were often effective if topicals failed. Discontinuation of the inciting TNFi with/without other interventions improved/resolved TNFi-psoriasis in 67% of refractory cases, while switching TNFis resulted in persistence/recurrence in 64%.

Limitations: Retrospective nature of study and some patients may have developed typical psoriasis unresponsive to TNFis,

Conclusion: This represents the largest single-institution cohort of TNFi-psoriasis patients diagnosed and (co)managed by dermatologists to date. Based on our findings we propose a treatment algorithm for TNFi-psoriasis.


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