Do Anti-TNF Agents Increase Psoriasis Risk In IBD Patients?

July 10, 2018

Anti-tumor necrosis factor (TNF) agents increase the risk of psoriasiform diseases among patients with inflammatory bowel diseases (IBD), according to the findings of a recent study.

Reports of patients developing psoriasiform diseases after initiating TNF therapies are increasing. To determine the risks of developing paradoxical psoriasiform diseases following anti-TNF agents, researchers conducted a nationwide population study using the Korea National Health Insurance Claim Data, which included 50,502 individuals with IBD. They compared a sample of 5428 individuals treated with anti-TNF agents for more than 6 months with 10,856 anti-TNF-naïve, matched controls.
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Compared with the control group, individuals exposed to anti-TNF agents had significantly higher incidence of psoriasis (hazard ratio [HR] 2.357). Individuals receiving anti-TNF agents had a higher risk for developing palmoplantar pustulosis (HR 9.355) and psoriatic arthritis (HR 2.926).

In sub-group analyses, the HRs for psoriasis were 2.549 and 2.105 for Crohn disease and ulcerative colitis, respectively. Patients aged 10 to 39 years and men had significantly higher risks for palmoplantar pustulosis (HR 19.682 and HR 14.318, respectively). However, patients aged 40 years and older and women showed similar rates between groups.

“The risk of psoriasiform diseases are increased by anti-TNF agents in patients with IBD,” the researchers concluded. “Among psoriasiform diseases, the risk of palmoplantar pustulosis shows the biggest increase particularly in male and younger patients.”


Bae JM, Lee HH, Lee BI, et al. Incidence of psoriasiform diseases secondary to tumour necrosis factor antagonists in patients with inflammatory bowel disease: a nationwide population-based cohort study. Aliment Pharmacol Ther. 2018;48(2):196-205.