The therapeutic potential of TNF-alpha antagonists for skin psoriasis comorbidities.
BACKGROUND
Alopecia, psoriatic arthritis, the metabolic syndrome, inflammatory bowel diseases and cardiovascular diseases may occur as skin psoriatic comorbidities. TNF-alpha antagonists are used to treat psoriasis. Adalimumab is one of the recognized active agents for this indication.


METHODS
The current peer-reviewed publications and presentation of original findings.


RESULTS
Adalimumab is active on recalcitrant psoriasis and some of its comorbidities, particularly arthropathies and Crohn's disease. However, the progression of the radiological alterations is limited with regression of the bony erosions. Psoriatic enthesopathy also regresses. Mortality associated with psoriasis arthropathy is on the decline. Crohn's disease, the most frequent inflammatory bowel comorbidity of psoriasis, is responsive to adalimumab. The effect of adalimumab on the metabolic syndrome and cardiovascular involvement is more erratic. The spectacular effects of adalimumab may be associated with some adverse effects. In particular, despite a marked reduction in the psoriasis area-and-severity index (PASI) score some new acute lesions of cutaneous psoriasis may develop corresponding to paradoxical psoriasis. Other potential adverse effects include infections, granulomas, rapid growth of cancers and occurrence of lymphomas.


CONCLUSIONS
Adalimumab frequently controls moderate-to-severe forms of cutaneous psoriasis and some of its comorbidities.
Piérard
Gérald E
GE
University Hospital Sart Tilman, Department of Dermatopathology, Liège, Belgium. gerald.pierard@ulg.ac.be
Piérard-Franchimont
Claudine
C
Szepetiuk
Grégory
G
Paquet
Philippe
P
Quatresooz
Pascale
P
D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000276:immunology; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000276:immunology; D015897:Comorbidity; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D024821:Metabolic Syndrome / Q000188:drug therapy / Q000276:immunology; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab