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Abstract
Objective We aimed to investigate the relationship between tumour necrosis factor inhibitors (TNFi) therapy and the onset of new psoriasis in children with juvenile idiopathic arthritis (JIA) using Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry data.
Methods De-identified data were obtained from the CARRA Registry. Patients with inflammatory bowel disease or psoriasis documented on or prior to JIA diagnosis date or with incomplete data were excluded. Exposure to TNFi was categorised as: (1) ever use; (2) current use or (3) first use only. Adjusted HRs (aHRs) were calculated between exposed and unexposed groups adjusted for methotrexate exposure, sex, race, family history of psoriasis and initial JIA category.
Results A total of 8225 patients were included with a median follow-up of 3.9 years. Over half of the patients were prescribed TNFi (n=4437, 54%). The aHR of new onset of psoriasis after ever exposure to TNFi was 2.93 (2.15 to 3.98). The incidence rate of psoriasis was the highest in children ever receiving and actively receiving adalimumab. Ever concurrent methotrexate use (HR 0.45, 0.29 to 0.69) was associated with lower risk.
Conclusion In a large prospective JIA patient registry, we observed a nearly threefold increased risk of psoriasis after TNFi exposureCite Now
- arthritis
- juvenile
- tumor necrosis factor inhibitors
- arthritis
- psoriatic
Data availability statement
Data may be obtained from a third party and are not publicly available. Original data request can be made through Childhood Arthritis and Rheumatology Research Alliance via info@carragroup.org and the data analysis protocol can be requested through YZ.
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Data availability statement
Data may be obtained from a third party and are not publicly available. Original data request can be made through Childhood Arthritis and Rheumatology Research Alliance via info@carragroup.org and the data analysis protocol can be requested through YZ.
Footnotes
Handling editor Josef S Smolen
Contributors Study conception and design and data collection: YZ, MBS and TB. Analysis and interpretation of results, draft manuscript preparation, reviewed the results and approved the final version of the manuscript: all authors. YZ accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.
Funding This research was funded by a Childhood Arthritis and Rheumatology Research Alliance Registry data analysis grant.
Competing interests YZ receives research funding from Childhood Arthritis and Rheumatology Research Alliance (CARRA), ACR/EULAR, Bristol-Myers Squibb and Washington Research Foundation and consultant fees from Novartis. MBS receives funding from CARRA, the Centers for Disease Control and Disease Prevention, PCORI and the Samara Jan Turkel Clinical Center for Autoimmune Disease. TB receives funding from CARRA and consultant fees from UCB and Novartis.
Provenance and peer review Not commissioned; externally peer reviewed.
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