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Inflamm Bowel Dis. 2016 Apr;22(4):894-901. doi: 10.1097/MIB.0000000000000757.

Incidence, Clinical Characteristics, and Management of Psoriasis Induced by Anti-TNF Therapy in Patients with Inflammatory Bowel Disease: A Nationwide Cohort Study.

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1Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Madrid, Spain; 2Department of Gastroenterology, Hospital Clinic, Barcelona, Spain; 3Department of Gastroenterology, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD); 4Department of Gastroenterology, Hospital Universitario La Fe, Valencia, Spain; 5Department of Gastroenterology, Consorci Sanitari de Terrassa, Barcelona, Spain; 6Department of Gastroenterology, Corporació Sanitaria Parc Taulí, Sabadell, Spain; 7Department of Gastroenterology, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain; 8Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; 9Department of Gastroenterology, Hospital de Manises, Valencia, Spain; 10Department of Gastroenterology, Hospital Clínico de Valencia, Universitat de València, Valencia, Spain; 11Department of Gastroenterology, Hospital de Basurto, Bilbao, Spain; 12Department of Gastroenterology, Hospital del Mar, Barcelona, Spain; 13Department of Gastroenterology, Hospital Universitario de Salamanca, Salamanca, Spain; 14Department of Gastroenterology, Hospital Reina Sofía, IMIBIC, Universidad de Córdoba, Córdoba, Spain; 15Department of Gastroenterology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain; 16Department of Gastroenterology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; 17Department of Gastroenterology, Hospital Universitario La Paz, Madrid, Spain; 18Department of Gastroenterology, Hospital Universitario Santa Lucía, Cartagena, Spain; 19Department of Gastroenterology, Hospital Universitario de Burgos, Burgos, Spain; 20Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain; 21Department of Gastroenterology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain; 22Department of Gastroenterology, Hospital Universitario Marqué



Psoriasis induced by anti-tumor necrosis factor-α (TNF) therapy has been described as a paradoxical side effect.


To determine the incidence, clinical characteristics, and management of psoriasis induced by anti-TNF therapy in a large nationwide cohort of inflammatory bowel disease patients.


Patients with inflammatory bowel disease were identified from the Spanish prospectively maintained Estudio Nacional en Enfermedad Inflamatoria Intestinal sobre Determinantes genéticos y Ambientales registry of Grupo Español de Trabajo en Enfermedad de Croh y Colitis Ulcerosa. Patients who developed psoriasis by anti-TNF drugs were the cases, whereas patients treated with anti-TNFs without psoriasis were controls. Cox regression analysis was performed to identify predictive factors.


Anti-TNF-induced psoriasis was reported in 125 of 7415 patients treated with anti-TNFs (1.7%; 95% CI, 1.4-2). The incidence rate of psoriasis is 0.5% (95% CI, 0.4-0.6) per patient-year. In the multivariate analysis, the female sex (HR 1.9; 95% CI, 1.3-2.9) and being a smoker/former smoker (HR 2.1; 95% CI, 1.4-3.3) were associated with an increased risk of psoriasis. The age at start of anti-TNF therapy, type of inflammatory bowel disease, Montreal Classification, and first anti-TNF drug used were not associated with the risk of psoriasis. Topical steroids were the most frequent treatment (70%), achieving clinical response in 78% of patients. Patients switching to another anti-TNF agent resulted in 60% presenting recurrence of psoriasis. In 45 patients (37%), the anti-TNF therapy had to be definitely withdrawn.


The incidence rate of psoriasis induced by anti-TNF therapy is higher in women and in smokers/former smokers. In most patients, skin lesions were controlled with topical steroids. More than half of patients switching to another anti-TNF agent had recurrence of psoriasis. In most patients, the anti-TNF therapy could be maintained.

[Indexed for MEDLINE]

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