Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Ängsäter, M.
Anti-TNF-a induced psoriasis
Humanmedizin; [ Diplomarbeit ] Graz Medical University; 2018. pp. 120
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Gruber-Wackernagel Alexandra
- Weger Wolfgang
- Altmetrics:
- Abstract:
- Background: Since their introduction more than a decade ago, tumor necrosis factors alpha (TNF-a) inhibitors have shown to significantly improve the treatment of patients with refractory, severe chronic immune-mediated inflammatory diseases (IMIDs) such as rheumatoid arthritis (RA), inflammatory bowel disease (IBD), ankylosing spondylitis (AS), psoriasis and psoriatic arthritis (PsA). TNF-a has been shown to have a pivotal role in the immunopathogenesis of these diseases. However, up to 5.3 % of patients treated with TNF-a inhibitors develop anti-TNF-a induced psoriasis. Objective: The aim of this study was to examine the clinical characteristics and outcomes of patients suffering from anti-TNF-a induced psoriasis. Methods: A thorough literature review was performed to collect the relevant data for the time period between 1999 and 2016. Results: In total, 434 cases (281 females, 153 males, mean age 41.1 years) of anti-TNF-a induced psoriasis were analyzed. The compiled data of our literature review revealed that most cases of anti-TNF-a induced psoriasis were attributable to infliximab (n=235/434, 54.1 %), followed by adalimumab (n=116/434, 26.7 %) and etanercept (n=74/434, 17.1 %). Complete resolution was observed in 33.1 % of the patients (n=44/133), who continued anti-TNF-a therapy with the causative agent and in 45.0 % of the patients (n=77/171), who discontinued therapy with the inculpated anti-TNF therapeutic. Interestingly, in 24.0 % (n=12/50) of the patients, who switched to a 2nd TNF-a inhibitor, a complete resolution was achieved. Conclusion: Concerning the treatment of anti-TNF-a induced psoriasis, there is a significant lack of data, how to treat it most efficiently. Whether the causative TNF-a inhibitor might further be used, when combined with topical medication, or can be switched to another TNF-a inhibitor or a biologic with a different mode of action (e.g. ustekinumab), remains an open question. Therefore, prospective studies addressing this question and the development of guidelines as well as treatment algorithms for anti-TNF-a induced psoriasis are of utmost importance.