ARTRITIS REUMATOIDE y psoriasis farmacológica inducida

DERMATOLOGÍA
El tratamiento de la artritis reumatoide con anti-TNF induce psoriasis
JANO.es · 11 Febrero 2009 10:45

Paradójicamente, las terapias anti-TNF son muy efectivas para tratar la psoriasis grave y la artritis psoriásica


Cada vez hay más evidencias de que los inhibidores del factor de necrosis tumoral (TNF por sus siglas en lengua inglesa) que se usan para tratar la artritis reumatoide causan psoriasis.

En este sentido, el último estudio realizado por investigadores de la Universidad de Manchester (Reino Unido) y publicado en la revista Annals of the Rheumatic Diseases, se suma a la lista de casos de psoriasis en pacientes con artritis reumatoide tratados con inhibidores del TNF. En palabras de la Dra. Kimme L. Hyrich, directora del trabajo, “observamos 25 nuevos casos de psoriasis en nuestra cohorte de casi 10.000 pacientes con AR tratados con terapia anti-TNF, a diferencia de ningún caso en nuestro grupo de control sin tratamiento activo”.

Los autores analizaron datos sobre 9.826 pacientes tratados con anti-TNF y 2.880 personas tratadas con los llamados fármacos antirreumáticos modificadores de enfermedad (DMARDS, por sus siglas en lengua inglesa). Según los 25 casos de psoriasis, el equipo estima que la incidencia de nuevos casos fue de 1,04 por cada 1.000 personas por año en la cohorte tratada con los anti-TNF. Como apuntó la Dra. Hyrich, “estos resultados generan una paradoja interesante, ya que las terapias anti-TNF son muy efectivas para tratar la psoriasis grave y la artritis psoriásica. La explicación tras los casos informados sigue siendo desconocida”.

Por todo ello, como concluyen los autores, “se necesitan más estudios para comprender la etiología de esos casos, antes de sacar conclusiones definitivas sobre la asociación entre las terapias anti-TNF y la psoriasis o redactar las guías para el tratamiento específico de la enfermedad”.

Published Online First: 2 April 2008. doi:10.1136/ard.2007.087288
Annals of the Rheumatic Diseases 2009;68:209-215
Copyright © 2009 BMJ Publishing Group Ltd & European League Against Rheumatism

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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 Harrison1, W G Dixon1, K D Watson1, 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 John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, Kings College London, London, UK

Correspondence to:
Dr K Hyrich, ARC Epidemiology Unit, Stopford Building, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK; kimme.hyrich@manchester.ac.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.