title: Safety of anti-TNFα agents in the treatment of psoriasis and psoriatic arthritis.
abstract: BACKGROUND
  The efficacy and favorable safety profile of anti-tumor necrosis factor (TNF) agents in the treatment of psoriasis and psoriatic arthritis (PsA) are supported by several randomized controlled studies and meta-analyses. However, some concerns on the long-term safety of these drugs still exist, as these studies generally included small patient numbers and were performed in selected patient populations.
  
  
  OBJECTIVE
  This review presents and discusses current evidence on the safety of anti-TNFα agents in patients with psoriasis and PsA, with a focus on European registry studies and case reports of particular importance.
  
  
  METHODS
  Key studies on the safety of anti-TNFα agents in the treatment of adult patients with psoriasis or PsA were identified by a MEDLINE search (last updated 10 November 2011) based on several interrelated queries, with a focus on European registries. Other studies and case reports were included if deemed relevant. Studies concerning other conditions, such as rheumatoid arthritis (RA), were included as appropriate when data in psoriatic disease were unavailable or insufficient.
  
  
  RESULTS
  Available data on the safety of anti-TNFα agents such as etanercept in psoriasis and PsA appear reassuring, even if some concerns still exist. Most notably, data suggest a higher incidence of infection and lymphoma amongst patients treated with the anti-TNFα monoclonal antibodies infliximab and adalimumab compared with etanercept.
  
  
  CONCLUSIONS
  The overall safety profile of monoclonal antibodies in patients with psoriasis, PsA and RA seems less favorable than that of etanercept, particularly in terms of risk of infection and hepatotoxicity.
authors.affiliation: Department of Dermatology, University of Verona, Italy. giampiero.girolomoni@univr.it
authors.forename: Giampiero
authors.initials: G
authors.lastname: Girolomoni
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Altomare
authors.forename: Fabio
authors.initials: F
authors.lastname: Ayala
authors.forename: Enzo
authors.initials: E
authors.lastname: Berardesca
authors.forename: Piergiacomo
authors.initials: P
authors.lastname: Calzavara-Pinton
authors.forename: Sergio
authors.initials: S
authors.lastname: Chimenti
authors.forename: Andrea
authors.initials: A
authors.lastname: Peserico
authors.forename: Antonio
authors.initials: A
authors.lastname: Puglisi Guerra
authors.forename: Gino Antonio
authors.initials: GA
authors.lastname: Vena
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000453:epidemiology; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D007239:Infections / Q000139:chemically induced* / Q000453:epidemiology; D000069285:Infliximab; D008223:Lymphoma / Q000139:chemically induced* / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept