Paradoxical Psoriasis Secondary to Anti-Tnfa Agents in Patients with Ankylosing Spondylitis: A Nationwide Population-Based Cohort Study

Ki-Jo Kim¹, Jung Min Bae², Young Bin Joo³, In-Woon Baek⁴, Kyung-Su Park³ and Chul-Soo Cho⁴, ¹Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea, The Republic of, ²Dermatology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea, The Republic of, ³Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea, The Republic of, ⁴Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Ankylosing spondylitis (AS), anti-TNF therapy and psoriasis

Session Information

Date: Sunday, November 13, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster I: Axial and Peripheral Spondyloarthritis – Clinical Aspects, Imaging and Treatment

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Anti-tumor necrosis factor-alpha (anti-TNFa) agents are established as the mainstay of treatment for ankylosing spondylitis (AS). Recently, paradoxical induction or exacerbation of psoriatic skin reaction during anti-TNFα therapy has been reported. The aim of this study is to investigate the incidence of psoriatic skin reaction in AS patients following anti-TNFa therapy and to compare the risk across anti-TNFα agents.

Methods: A nationwide population-based cohort study was performed using the Korean National Health Insurance Claims database. All patients with AS were collected between 2009 and 2013. The case group (anti-TNFα therapy group) included all AS patients who had been treated with anti-TNFα agents for over 6 months, and an age- and sex-matched control group (conventional therapy group) was selected randomly, with two controls per case, from AS patients who had not been administered an anti-TNFα agent. Newly-developed psoriasis and palmoplantar pustulosis after 1-year washout period of 2009 were assessed and compared between the two groups using multivariable logistic regression models.

Results: Among a total of 36,311 AS patients, 5,838 and 11,676 patients were enrolled in the anti-TNFα and conventional therapy groups, respectively. The incidence rates of psoriasis and palmoplantar pustulosis in the anti-TNFα therapy group were significantly higher than those of conventional therapy group (1.66% vs. 0.80% for psoriasis and 0.48% vs. 0.13% for palmoplantar pustulosis, all P <0.0001). After adjusting for age and sex, the anti-TNFα therapy group had increased risks of psoriasis (odds ratio [OR] 2.112, 95% confidence interval [95% CI] 1.586–2.812) and palmoplantar pustulosis (OR 4.343, 95% CI 2.248–8.392). Infliximab (OR 2.801, 95% CI 1.793–4.375) had the highest association with incident psoriasis, followed by adalimumab (OR 1.980, 95% CI 1.359–2.886) and etanercept (OR 1.906, 95% CI 1.278–2.843).

Conclusion: The use of anti-TNFα agents was significantly associated with the development of paradoxical psoriasis and palmoplantar pustulosis in patients with AS.

Disclosure: K. J. Kim, None; J. M. Bae, None; Y. B. Joo, None; I. W. Baek, None; K. S. Park, None; C. S. Cho, None.

To cite this abstract in AMA style:

Kim KJ, Bae JM, Joo YB, Baek IW, Park KS, Cho CS. Paradoxical Psoriasis Secondary to Anti-Tnfa Agents in Patients with Ankylosing Spondylitis: A Nationwide Population-Based Cohort Study [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/paradoxical-psoriasis-secondary-to-anti-tnfa-agents-in-patients-with-ankylosing-spondylitis-a-nationwide-population-based-cohort-study/. Accessed .

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