American College of Rheumatology Annual Meeting

American College of Rheumatology Annual Meeting

November 25, 2019
2 min read

Exposure to TNF inhibitors increases psoriasis risk in children with IBD, JIA

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Children with inflammatory bowel disease, juvenile idiopathic arthritis and chronic noninfectious osteomyelitis had an increased rate of psoriasis, and those exposed to tumor necrosis factor inhibitor therapy exhibited the highest risk, according to research presented at the American College of Rheumatology/Association of Rheumatology Professionals annual meeting.

“TNF-alpha inhibiting therapies are a cornerstone of treatment for inflammatory conditions such as IBD, JIA and chronic noninfectious osteomyelitis but have been increasingly implicated in the development of psoriasis,” Lisa Buckley, MD, of Children’s Hospital of Philadelphia, and colleagues wrote in the abstract.

The single-center study of electronic health record data from 2008 to 2018 included 4,403 children under 19 years at diagnosis, each with at least two ICD-9 or ICD-10 codes for JIA, IBD or chronic noninfectious osteomyelitis and at least two visits with a study center rheumatologist or gastroenterologist.

Researchers defined TNF inhibitor exposure as at least one prescription for Humira (adalimumab, AbbVie), Enbrel (etanercept, Amgen) or Remicade (infliximab, Janssen), and patients were categorized as “ever” or “never” having TNF inhibitor exposure. The cohort was compared with the expected number of psoriasis cases in the general pediatric population, based on previously published data.

Among the cohort, 1,738 children (39%) had TNF inhibitor exposure and 2,665 (61%) did not, which included 5,245 person-years and 7,365 person-years of follow-up, respectively.

There were 64 cases of psoriasis (IR = 1.2 per 100 person-years) in children with TNF inhibitor exposure and 26 cases of psoriasis (IR = 0.4 per 100 person-years) in those not exposed.

The standardized incidence ratio was 17.5 for the entire cohort (95% CI, 14.2-21.5), 29.9 for the TNF inhibitor group (95% CI, 23.4-38.2) and 8.7 for the unexposed group (95% CI, 5.9-12.7), according to the abstract.

In comparing the TNF inhibitor exposure to those not exposed, the HR for psoriasis was 4.23 (95% CI, 2.56-7.01) when all other covariates were held constant.

Furthermore, those who were exposed to a TNF inhibitor and also had a family history of psoriasis had an independently associated increased HR of psoriasis (HR = 3.09; 95% CI, 1.82-5.22). – by Abigail Sutton



Buckley L, et al. Abstract #1816. Psoriasis associated with anti-tumor necrosis factor-alpha therapies in children with inflammatory bowel disease, juvenile idiopathic arthritis, and chronic noninfectious osteomyelitis. Presented at: American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; Nov. 9-13, 2019; Atlanta.


Disclosures: The authors report no relevant financial disclosures.