Article Text

Download PDFPDF
Psoriasis rate is increased by the exposure to TNF inhibition in children with JIA
  1. Yongdong Zhao1,2,
  2. Erin Sullivan1,
  3. Mary Beth Son3,
  4. Timothy Beukelman4
  1. 1 Center of Clincial and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
  2. 2 School of Medicine, University of Washington, Seattle, Washington, USA
  3. 3 Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4 School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Yongdong Zhao, Seattle Children's Research Institute, Seattle, Washington, USA; yongdong.zhao{at}seattlechildrens.org

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.

Statistics from Altmetric.com

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.

View Full Text

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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.