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Arthritis Care Res (Hoboken). 2019 Oct 23. doi: 10.1002/acr.24100. [Epub ahead of print]

Psoriasis Associated with Tumor Necrosis Factor-Alpha Inhibitors in Children with Inflammatory Diseases.

Author information

1
Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA.
2
Department of Pediatrics, Division of Rheumatology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.
3
Department of Pediatrics, Division of Biostatistics, Children's Hospital of Philadelphia, Philadelphia, PA.
4
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA.
5
Department of Pediatrics, Section of Dermatology, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
6
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA.
7
Department of Pediatrics and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Abstract

OBJECTIVE:

We aimed to estimate the incidence rate (IR) of psoriasis in children with inflammatory bowel disease (IBD), juvenile idiopathic arthritis (JIA), and chronic noninfectious osteomyelitis (CNO) with tumor necrosis factor-alpha inhibitor (TNFi) exposure as compared to those without TNFi exposure and to the general pediatric population.

METHODS:

This was a single-center retrospective cohort study of children with IBD, JIA, or CNO from 2008 to 2018. TNFi exposure was defined as a prescription for adalimumab, etanercept, infliximab, certolizumab, or golimumab, and the primary outcome was incident psoriasis. IRs and standardized incidence ratios (SIRs) were calculated. Cox proportional hazards models were used to assess the association of psoriasis with TNFi exposure and other risk factors.

RESULTS:

Of the 4111 children who met inclusion criteria, 1614 (39%) had TNFi exposure and 2497 (61%) did not with 4705 and 6604 person-years of follow-up, respectively. There were 58 (IR 12.3 per 1000 person-years) and 25 (IR 3.8 per 1000 person-years) cases of psoriasis in children with and without TNFi exposure, respectively. The SIR was 18 (95% confidence interval [CI] 15, 22) overall, 30 (95% CI 23, 39) for children with TNFi exposure, and 9.3 (95% CI 6.3, 14) for children without TNFi exposure. The hazard ratio (HR) of psoriasis comparing TNFi exposure to no TNFi exposure was 3.84 (95% CI 2.28, 6.47, p<0.001).

CONCLUSION:

Children with IBD, JIA, and CNO had an increased rate of psoriasis compared to the general pediatric population, with the highest rate in those with TNFi exposure.

PMID:
31646743
DOI:
10.1002/acr.24100

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