title: Paradoxical psoriasis in a large cohort of patients with inflammatory bowel disease receiving treatment with anti-TNF alpha: 5-year follow-up study.
abstract: BACKGROUND
  Psoriasis is an emerging paradoxical side effect in patients with inflammatory bowel disease (IBD) when treated with anti-TNF alpha. Patients with severe skin lesions unresponsive to topical therapy need to withdraw from treatment.
  
  
  OBJECTIVE
  To estimate the incidence of paradoxical psoriasis in a large cohort of IBD patients treated with anti-TNF alpha and to analyse its clinical correlates.
  
  
  METHODS
  A retrospective cohort study on all IBD patients who started anti-TNF alpha at our IBD Centre from January 2008 to December 2013 was performed. Proportional hazards regression models were used to estimate the association between each predictor and time to the development of psoriasis. Time-dependent predictors were updated at each available time point.
  
  
  RESULTS
  Four hundred and two patients were included. Participants contributed a total of 839 person-years of follow-up, during which 42 incident cases of psoriasis were recorded, with an incidence rate of five per 100 person-years. Cox-regression survival analysis revealed smoking as independent predictor of psoriasis (HR: 2.37, 95% CI: 1.36-4.48; P = 0.008). Conversely, concomitant immunosuppressive therapy was inversely related to psoriasis (HR: 0.33, 95% CI: 0.12-0.92; P = 0.03).
  
  
  CONCLUSIONS
  Paradoxical psoriasis is a relevant side effect of anti-TNF alpha therapy, with an incidence rate of five per 100 person-years. Smoking is confirmed as the main risk factor for developing lesions. The combination therapy with anti-TNF alpha plus immunosuppressants is associated with a reduced risk of paradoxical psoriasis.
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Pugliese
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Guidi
authors.affiliation: Nephrology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: P M
authors.initials: PM
authors.lastname: Ferraro
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Marzo
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Felice
authors.affiliation: Dermatology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Celleno
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Landi
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Andrisani
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pizzolante
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: I
authors.initials: I
authors.lastname: De Vitis
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Papa
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: G L
authors.initials: GL
authors.lastname: Rapaccini
authors.affiliation: IBD Unit, Internal Medicine and Gastroenterology, Complesso Integrato Columbus, Catholic University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Armuzzi
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy*; D000069285:Infliximab / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab