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)
- apremilast
*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}