Tumor necrosis factor-alpha antagonist therapy-induced psoriasis in Turkey: Analysis of 514 patients

Abstract

New adverse events are being reported with the increased use of anti-tumor necrosis factor (TNF) alpha therapy. We studied cases of anti-TNF alpha-induced psoriasis observed in our pool of 514 patients receiving anti-TNF alpha treatment in Turkey. Three rheumatoid arthritis patients and 3 ankylosing spondylitis patients with anti-TNF alpha-induced psoriasis were included in the study. All patients were examined by a dermatologist, and 3 patients underwent skin biopsy. None of the 6 patients had preexisting psoriasis or a familial history of psoriasis. The earliest and latest occurrences of psoriatic lesions were at the 6th week and 44th month of anti-TNF alpha therapy, respectively. Psoriasis was severe and refractory in two patients (requiring systemic treatment), while it presented as mild in four patients. Anti-TNF alpha therapy was totally withdrawn in case 1. In case 2, the treatment was halted for 3 months then switched to another TNF alpha blocker, and case 3 was switched to another anti-TNF alpha treatment. The treatment was sustained in the other 3 patients (cases 4, 5, and 6). TNF alpha blockers are very effective agents in the treatment of psoriasis, but it is interesting that the same molecules can, paradoxically, induce psoriasis. The occurrence of anti-TNF alpha-induced psoriasis in six out of 514 patients suggests that the incidence of this adverse reaction is, in fact, as not low as presumed in the literature. In some cases, a severe course of psoriasis may limit the use of these agents.