{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T13:06:23Z","timestamp":1785762383241,"version":"3.56.0"},"reference-count":27,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2022,9,1]]},"abstract":"Importance<\/jats:title>Tumor necrosis factor-\u03b1 inhibitor (TNFi)\u2013associated psoriasis is a rare adverse event following TNFi treatment. Data on the risk of developing TNFi-associated psoriasis when treated with TNFi are sparse.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the associated risk between new-onset psoriasis and TNFi treatment compared with nonbiologic conventional treatment.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>Using Danish national registries (1995-2018), this cohort study included patients with inflammatory bowel disease (IBD) and\/or rheumatoid arthritis (RA) who received either conventional therapy or TNFi treatment. Patients may not have been diagnosed with psoriasis prior to initiation of treatment. Patients were followed up for up to 5 years. Cox regression models with robust variance were used to compare the risk of developing any type of psoriasis, nonpustular psoriasis, and pustular psoriasis. Patients receiving conventional therapy were used as reference. Data analysis was performed from January 1995 to December 2018.<\/jats:p><\/jats:sec>Exposures<\/jats:title>For the present study, the term conventional therapy<\/jats:italic> was used for the nonbiological therapy. For biological therapy, a distinction was made between TNFi treatment and non-TNFi biological therapy.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The outcome of psoriasis was defined as a registered International Statistical Classification of Diseases and Related Health Problems, Tenth Revision <\/jats:italic>code of psoriasis and\/or having 2 consecutive prescriptions of topical vitamin D analogues.<\/jats:p><\/jats:sec>Results<\/jats:title>The study included 109\u202f085 patients, of which 62% were female. Median (IQR) age was 50 (34-64) years. Of the included patients, 108\u202f024 received conventional therapy and 20\u202f910 received TNFi treatment. During follow-up, 1471 (1.4%) patients developed any type of psoriasis, of which 1332 developed nonpustular psoriasis, 127 patients developed palmoplantar pustulosis, and 12 patients developed generalized pustulosis. The incidence rates for developing any type of psoriasis per 1000 patient-years were 3.0 (95% CI, 2.9-3.2) for conventional therapy and 7.8 (95% CI, 7.5-8.9) for TNFi. During treatment with TNFi, the hazard ratio was 2.12 (95% CI, 1.87-2.40; P<\/jats:italic>\u2009&lt;\u2009.001) for developing nonpustular psoriasis and 6.50 (95% CI, 4.60-9.23; P<\/jats:italic>\u2009&lt;\u2009.001) for pustular psoriasis compared with conventional treatment. Exposure needed for 1 additional patient to be harmed was 241 patient-years for any type of TNFi-associated psoriasis, 342 patient-years for nonpustular psoriasis, and 909 patient-years for pustular psoriasis.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In a Danish nationwide cohort of patients with immune-mediated inflammatory diseases treated with TFNi or conventional treatment and no history of psoriasis, in TFNi-treated patients, nonpustular types of psoriasis constituted the most events, whereas pustular types of psoriasis had the highest relative risk. Although the risk of new-onset psoriasis increased for both nonpustular and pustular types of psoriasis in TFNi-treated patients, the absolute risk remained modest at 241 patient-years of exposure need for 1 additional event and an estimated absolute risk difference around 5 per 1000 patient-years, indicating that the approach to treatment of patients in need of TNFi treatment should not change.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2022.2360","type":"journal-article","created":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T15:40:59Z","timestamp":1656517259000},"page":"997","source":"Crossref","is-referenced-by-count":13,"title":["Absolute and Relative Risk of New-Onset Psoriasis Associated With Tumor Necrosis Factor-\u03b1 Inhibitor Treatment in Patients With Immune-Mediated Inflammatory Diseases"],"prefix":"10.1001","volume":"158","author":[{"given":"David","family":"Thein","sequence":"first","affiliation":[{"name":"Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark"},{"name":"Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark"},{"name":"Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Egeberg","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lone","family":"Skov","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark"},{"name":"Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolai","family":"Loft","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark"},{"name":"Copenhagen Research Group for Inflammatory Skin, Herlev and Gentofte Hospital, Hellerup, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"6","key":"doi220030r1","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1038\/s41385-018-0050-3","article-title":"The current state of the art for biological therapies and new small molecules in inflammatory bowel disease.","volume":"11","author":"Paramsothy","year":"2018","journal-title":"Mucosal Immunol"},{"issue":"6","key":"doi220030r2","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1016\/j.clinthera.2011.05.044","article-title":"Use of biologics in rheumatoid arthritis: current and emerging paradigms of care.","volume":"33","author":"Curtis","year":"2011","journal-title":"Clin Ther"},{"issue":"6","key":"doi220030r3","doi-asserted-by":"publisher","first-page":"817","DOI":"10.2217\/imt.10.67","article-title":"Anti-TNF-a agents in the treatment of immune-mediated inflammatory diseases: mechanisms of action and pitfalls.","volume":"2","author":"Silva","year":"2010","journal-title":"Immunotherapy"},{"issue":"2","key":"doi220030r4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008794.pub2","article-title":"Adverse effects of biologics: a network meta-analysis and Cochrane overview.","volume":"2011","author":"Singh","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"issue":"12","key":"doi220030r5","doi-asserted-by":"publisher","first-page":"1183","DOI":"10.1080\/17474124.2018.1545574","article-title":"Adverse events in IBD therapy: the 2018 update.","volume":"12","author":"Quezada","year":"2018","journal-title":"Expert Rev Gastroenterol Hepatol"},{"issue":"6","key":"doi220030r6","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1111\/jdv.v34.6","article-title":"Adverse events with IL-17 and IL-23 inhibitors for psoriasis and psoriatic arthritis: a systematic review and meta-analysis of phase III studies.","volume":"34","author":"Loft","year":"2020","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"3","key":"doi220030r7","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1111\/1346-8138.14096","article-title":"Safety of biologics in psoriasis.","volume":"45","author":"Kamata","year":"2018","journal-title":"J Dermatol"},{"issue":"5","key":"doi220030r8","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1111\/bjd.2009.161.issue-5","article-title":"Cytokine imbalance with increased production of interferon-alpha in psoriasiform eruptions associated with antitumour necrosis factor-alpha treatments.","volume":"161","author":"Seneschal","year":"2009","journal-title":"Br J Dermatol"},{"issue":"1","key":"doi220030r9","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1038\/s41467-017-02466-4","article-title":"TNF blockade induces a dysregulated type I interferon response without autoimmunity in paradoxical psoriasis.","volume":"9","author":"Conrad","year":"2018","journal-title":"Nat Commun"},{"issue":"2","key":"doi220030r10","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1016\/j.jaad.2016.08.012","article-title":"Tumor necrosis factor-a inhibitor-induced psoriasis: systematic review of clinical features, histopathological findings, and management experience.","volume":"76","author":"Brown","year":"2017","journal-title":"J Am Acad Dermatol"},{"issue":"11-12","key":"doi220030r11","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1111\/apt.2011.34.issue-11-12","article-title":"Psoriasis associated with anti-tumour necrosis factor therapy in inflammatory bowel disease: a new series and a review of 120 cases from the literature.","volume":"34","author":"Cullen","year":"2011","journal-title":"Aliment Pharmacol Ther"},{"issue":"7","key":"doi220030r12","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1111\/apt.13352","article-title":"Paradoxical psoriasis in a large cohort of patients with inflammatory bowel disease receiving treatment with anti-TNF alpha: 5-year follow-up study.","volume":"42","author":"Pugliese","year":"2015","journal-title":"Aliment Pharmacol Ther"},{"issue":"2","key":"doi220030r13","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1136\/ard.2007.087288","article-title":"Rates of new-onset psoriasis in patients with rheumatoid arthritis receiving anti-tumour necrosis factor a therapy: results from the British Society for Rheumatology Biologics Register.","volume":"68","author":"Harrison","year":"2009","journal-title":"Ann Rheum Dis"},{"issue":"3","key":"doi220030r14","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1093\/ecco-jcc\/jjz152","article-title":"Global prevalence and bidirectional association between psoriasis and inflammatory bowel disease\u2014a systematic review and meta-analysis.","volume":"14","author":"Alinaghi","year":"2020","journal-title":"J Crohns Colitis"},{"issue":"3","key":"doi220030r15","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1111\/bjd.14528","article-title":"Association between psoriasis and inflammatory bowel disease: a Danish nationwide cohort study.","volume":"175","author":"Egeberg","year":"2016","journal-title":"Br J Dermatol"},{"issue":"2","key":"doi220030r16","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2018-000656","article-title":"Distinguishing rheumatoid arthritis from psoriatic arthritis.","volume":"4","author":"Merola","year":"2018","journal-title":"RMD Open"},{"issue":"1","key":"doi220030r17","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s13075-019-1980-1","article-title":"Risk of immune-mediated inflammatory diseases in newly diagnosed ankylosing spondylitis patients: a population-based matched cohort study.","volume":"21","author":"Chen","year":"2019","journal-title":"Arthritis Res Ther"},{"issue":"10","key":"doi220030r18","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1080\/00365521.2020.1807598","article-title":"Validation of ulcerative colitis and Crohn\u2019s disease and their phenotypes in the Danish National Patient Registry using a population-based cohort.","volume":"55","author":"Lo","year":"2020","journal-title":"Scand J Gastroenterol"},{"key":"doi220030r19","doi-asserted-by":"publisher","first-page":"627","DOI":"10.2147\/CLEP","article-title":"Validity and completeness of rheumatoid arthritis diagnoses in the nationwide DANBIO clinical register and the Danish National Patient Registry.","volume":"9","author":"Ibfelt","year":"2017","journal-title":"Clin Epidemiol"},{"issue":"2","key":"doi220030r20","doi-asserted-by":"publisher","first-page":"e90","DOI":"10.1111\/jdv.v34.2","article-title":"Use of topical calcipotriol for identification of patients with psoriasis in administrative healthcare data\u2014a validation study.","volume":"34","author":"Egeberg","year":"2020","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"11","key":"doi220030r21","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.2340\/00015555-3278","article-title":"Validation of psoriasis diagnoses in the Danish national patient register.","volume":"99","author":"Loft","year":"2019","journal-title":"Acta Derm Venereol"},{"issue":"8","key":"doi220030r22","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1002\/pds.v23.8","article-title":"Measures of \u2018exposure needed for one additional patient to be harmed\u2019 in population-based case-control studies.","volume":"23","author":"Hallas","year":"2014","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"4","key":"doi220030r23","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1097\/MIB.0000000000000757","article-title":"Incidence, clinical characteristics, and management of psoriasis induced by Anti-TNF therapy in patients with inflammatory bowel disease: a nationwide cohort study.","volume":"22","author":"Guerra","year":"2016","journal-title":"Inflamm Bowel Dis"},{"issue":"12","key":"doi220030r24","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1001\/jamadermatol.2018.3631","article-title":"Association of psoriasis with inflammatory bowel disease: a systematic review and meta-analysis.","volume":"154","author":"Fu","year":"2018","journal-title":"JAMA Dermatol"},{"issue":"6","key":"doi220030r25","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1016\/j.jaad.2018.12.018","article-title":"TNF-a inhibitor-induced psoriasis: a decade of experience at the Cleveland Clinic.","volume":"83","author":"Mazloom","year":"2020","journal-title":"J Am Acad Dermatol"},{"issue":"12","key":"doi220030r26","doi-asserted-by":"publisher","first-page":"1048","DOI":"10.1016\/j.cgh.2010.07.022","article-title":"Severe skin lesions cause patients with inflammatory bowel disease to discontinue anti-tumor necrosis factor therapy.","volume":"8","author":"Rahier","year":"2010","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"3","key":"doi220030r27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-028116","article-title":"Prevalence and characteristics of psoriasis in Denmark: findings from the Danish skin cohort.","volume":"9","author":"Egeberg","year":"2019","journal-title":"BMJ Open"}],"container-title":["JAMA Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/articlepdf\/2793425\/jamadermatology_thein_2022_oi_220030_1662573746.68769.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T15:09:23Z","timestamp":1663772963000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2793425"}},"subtitle":["A Danish Nationwide Cohort Study"],"short-title":[],"issued":{"date-parts":[[2022,9,1]]},"references-count":27,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2022,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamadermatol.2022.2360","relation":{},"ISSN":["2168-6068"],"issn-type":[{"value":"2168-6068","type":"print"}],"subject":[],"published":{"date-parts":[[2022,9,1]]}}}