Section : Notes de congrès/conférences

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


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}