Psoriasis Associated With Tumor Necrosis Factor Inhibitors in Children With Inflammatory Diseases

Area of Science:

• Pediatric Rheumatology
• Dermatology
• Gastroenterology

Background:

• Psoriasis incidence is elevated in pediatric patients with IBD, JIA, and CNO.
• The role of tumor necrosis factor inhibitors (TNFi) in the development of psoriasis in these pediatric populations requires further investigation.

Purpose of the Study:

• To estimate the incidence rate (IR) of psoriasis in children with IBD, JIA, and CNO.
• To compare psoriasis incidence between children exposed to TNFi and those not exposed.
• To compare psoriasis incidence in these pediatric cohorts to the general pediatric population.

Main Methods:

• Retrospective cohort study of 4,111 children diagnosed with IBD, JIA, or CNO between 2008 and 2018.
• TNFi exposure defined by prescription of specific biologic agents (adalimumab, etanercept, infliximab, certolizumab, golimumab).
• Incident psoriasis was the primary outcome, with IRs, standardized incidence ratios (SIRs), and Cox proportional hazards models used for analysis.

Main Results:

• Children with TNFi exposure had a significantly higher incidence of psoriasis (12.3 per 1,000 person-years) compared to those without TNFi exposure (3.8 per 1,000 person-years).
• The standardized incidence ratio (SIR) for psoriasis was 18 overall, with higher rates in the TNFi-exposed group (SIR 30) versus the unexposed group (SIR 9.3).
• TNFi exposure was associated with a 3.84-fold increased hazard of developing psoriasis (95% CI 2.28-6.47; P < 0.001).

Conclusions:

• Pediatric patients with IBD, JIA, and CNO exhibit an increased incidence of psoriasis compared to the general pediatric population.
• TNFi therapy in these pediatric cohorts is associated with a substantially higher risk of developing psoriasis.
• Further research is warranted to understand the mechanisms and management strategies for psoriasis in pediatric patients on TNFi therapy.