RESEARCH - Rates of new-onset psoriasis in patients with RA receiving anti-TNF therapy: British Society for Rheumatology Biologics Register

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Published Online First: 2 April 2008. doi:10.1136/ard.2007.087288

ls of the Rheumatic Diseases 2009;68:209-215

BMJ Publishing Group Ltd & European League Against Rheumatism.

CLINICAL AND EPIDEMIOLOGICAL RESEARCH

Rates of new-onset psoriasis in patients with rheumatoid arthritis

receiving anti-tumour necrosis factor therapy: results from the

British Society for Rheumatology Biologics Register

M J on1, W G Dixon1, K D 1, Y King1, R Groves2, K L

Hyrich1, D P M Symmons1, and the British Society for Rheumatology

Biologics Register Control Centre Consortium on behalf of the BSRBR

1 ARC Epidemiology Unit, The University of Manchester, Manchester, UK

2 St ’s Institute of Dermatology, Division of Genetics and

Molecular Medicine, Kings College London, London, UK

Background: Anti-tumour necrosis factor (TNF) treatments improve

outcome in severe rheumatoid arthritis (RA) and are efficacious in

psoriasis and psoriatic arthritis. However recent case reports

describe psoriasis occurring as an adverse event in patients with RA

receiving anti-TNF therapy.

Objectives: We aimed to determine whether the incidence rate of

psoriasis was higher in patients with RA treated with anti-TNF therapy

compared to those treated with traditional disease-modifying

antirheumatic drugs (DMARDs). We also compared the incidence rates of

psoriasis between the three anti-TNF drugs licensed for RA.

Methods: We studied 9826 anti-TNF-treated and 2880 DMARD-treated

patients with severe RA from The British Society for Rheumatology

Biologics Register (BSRBR). All patients reported with new onset

psoriasis as an adverse event were included in the analysis. Incidence

rates of psoriasis were calculated as events/1000 person years and

compared using incidence rate ratios (IRR).

Results: In all, 25 incident cases of psoriasis in patients receiving

anti-TNF therapy and none in the comparison cohort were reported

between January 2001 and July 2007. The absence of any cases in the

comparison cohort precluded a direct comparison; however the crude

incidence rate of psoriasis in those treated with anti-TNF therapy was

elevated at 1.04 (95% CI 0.67 to 1.54) per 1000 person years compared

to the rate of 0 (upper 97.5% CI 0.71) per 1000 person years in the

patients treated with DMARDs. Patients treated with adalimumab had a

significantly higher rate of incident psoriasis compared to patients

treated with etanercept (IRR 4.6, 95% CI 1.7 to 12.1) and infliximab

(IRR 3.5, 95% CI 1.3 to 9.3).

Conclusions: Results from this study suggest that the incidence of

psoriasis is increased in patients treated with anti-TNF therapy. Our

findings also suggest that the incidence may be higher in patients

treated with adalimumab.

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http://ard.bmj.com/cgi/content/full/68/2/209

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