Development of paradoxical inflammatory disorders during treatment of psoriasis with TNF inhibitors: a review of published cases

Abstract

Background

TNF inhibitors have proven to be effective and relatively safe in the management of psoriasis. While infections and certain malignancies are established as acknowledged side effects, paradoxical inflammatory, non-neoplastic, noninfectious adverse events are being recognized less frequently. We aimed to identify published, peer-reviewed cases of paradoxical inflammatory, non-neoplastic, noninfectious adverse events in psoriasis patients during TNF inhibitor therapy.

Methods

A literature search in MEDLINE was performed for articles published from inception through the 8th of June 2016 that reported suspected incidents fulfilling a predefined search strategy. In addition, articles identified by reference lists were added.

Results

A total of 295 cases from various organ systems among 13 269 patients were identified: 91 cases were related to infliximab, 101 cases were related to etanercept, and 102 cases were related to adalimumab. One case report was related to both etanercept and adalimumab.

Conclusion

Induction of paradoxical non-neoplastic noninflammatory adverse events in psoriasis patients treated with a TNF inhibitor is worth recognizing. The amount of cases identified by this study suggests that continuous surveillance and research into these adverse effects is relevant. Nondermatologic paradoxical inflammatory reactions may be underreported.

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