Discontinuation of inciting agent helps resolve TNFI-induced psoriasis

A treatment algorithm is needed for tumour necrosis factor-α (TNF-α) inhibitor (TNFI)-induced psoriasis, suggests a study with a cohort representing the largest single-institution group of patients with TNFI-induced psoriasis diagnosed and managed or comanaged by dermatologists to date.

The authors retrospectively reviewed patients in whom TNFI-induced psoriasis was diagnosed between 2003 and 2013. They identified 102 patients with the said condition (mean age at onset, 40 years; 73.5 percent women).

The most frequent primary conditions in this cohort were Crohn’s disease (48 percent) and rheumatoid arthritis (24.5 percent). Infliximab (52 percent) was the most common inciting agent. The top three TNFI-induced subtypes were plaque-type psoriasis (48.5 percent), scalp psoriasis (47.5 percent), and palmoplantar pustulosis (41 percent).

Treatment with topical medications alone resulted in improvement or resolution of TNFI-induced psoriasis in majority of the patients (63.5 percent). Cyclosporine and methotrexate (>10 mg weekly) were often effective if topicals failed.

Discontinuation of the inciting TNFI with or without other interventions led to improved or resolved TNFI-induced psoriasis in 67 percent of refractory patients. On the other hand, switching to other TNFIs led to persistent or recurrent disease in 64 percent of patients.

The study was limited by its retrospective design and the fact that some patients may have developed typical psoriasis unresponsive to TNFIs, according to the authors.

“TNFI-induced psoriasis remains poorly understood despite having been described 15 years ago. As TNFIs often provide life-changing patient benefits, understanding effective treatments for TNFI-induced psoriasis is important,” they authors said.