Psoriasis-induced by Injected anti-TNF drugs (Paradoxical adverse, reactions): Oral non-TNF targeted therapies ?

• The development of psoriasis has been observed in anti-TNF therapies for the treatment of Rheumatoid Arthritis, Ankylosing Spondylitis and Behcet’s disease.
• Its incidence is estimated to occur in around  5% of cases and is more frequent in females than males.
• It occurs 5 days to several months after the initiation of treatment in patients in remission of arthritis.
• Other observed reactions include:
  • granulomatous reactions such as Crohn’s disease estimated to occur in 0.15% of patients receiving etanercept.
  • neutrophilic reactions such hidradenitis suppurativa (Verneuil’s disease) and pyoderma gangrenosum
• Practical attitude:
  • evaluate the severity of the condition
  • evaluate the need to use anti-TNF therapy
  • try non-systemic therapies: topicals, phototherapy.
  • stop the anti-TNF
• Oral therapies targeting non TNF molecules* are available to treat psoriasis:
  • apremilast
    • a phosphodiesterase 4 (specific) inhibitor which results in tyrosine kinase pathway inhibition
    • it is approved by the FDA since september 2014 and in early 2015 in Europe for the treatment of moderate-to-severe psoriasis.
    • available at a dosage of 30mg twice a day
    • trials have not shown the side effects of anti-TNF drugs and it remains to be seen if such adverse side effects would be observed.
  • tofacitinib:
    • an inhibitor of janus kinase 3
    • it is currently being evaluated and is not yet available on the market (as of today)

*also called small molecules

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Bibliography: Aubain F 22nd meeting of alpine dermatologists (23.1.2015) – Chamonix, France  {Aubain F. 22e rencontres des dermatologues alpins (23.1.2015) – Chamonix, France}