Tumor Necrosis Factor-α Inhibitor Use in Psoriasis Patients With a First-degree Relative With Multiple Sclerosis.
Tumor necrosis factor (TNF)-α inhibitors are currently the gold standard for treating moderate to severe plaque psoriasis and other immune-mediated diseases. The presence of previously existing demyelinating disease is amongst the contraindications to their use. However, controversy surrounds the use of TNF-α inhibitors in patients who are more predisposed to developing multiple sclerosis (MS), specifically first-degree relatives of MS patients. In fact, the major guidelines committees' recommendations on this issue by the American Academy of Dermatology, the British Association of Dermatologists, and the European S3-Guidelines are not consistent. The data we present suggest that the number needed to treat is at least an order of magnitude smaller than the number needed to harm across all comparisons of anti-TNF-α agents and first-degree relative relationships. Based on these data, physicians could weigh the treatment options available and work closely with neurological colleagues when prescribing anti-TNF-α therapy in this patient population rather than practicing absolute prohibition of anti-TNF-α agents in patients who have a first-degree relative with MS.
Bobbak
B
Mansouri
Mary E
ME
Horner
Alan
A
Menter
D000075202:Contraindications; D003879:Dermatologic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D009103:Multiple Sclerosis / Q000139:chemically induced / Q000453:epidemiology* / Q000235:genetics; D061366:Numbers Needed To Treat; D010375:Pedigree; D017410:Practice Guidelines as Topic; D011565:Psoriasis / Q000188:drug therapy* / Q000235:genetics; D018570:Risk Assessment; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha