Spondyloarthritis & psoriatic arthritis
The predictors of paradoxical reactions, especially psoriasis, to biologic therapy—findings from the TReasure database: a 5-year follow-up study
Authors' conclusion
Contrary to expectations based on earlier research suggesting that paradoxical reactions develop with the class effect of biological agents, the response of patients who were shifted to another TNFi was favourable.
Study context
- Population
- Patients with RA and SpA on biologic therapy, 17 centres in Turkey, since 20172,867 RA and 5316 SpA
- Comparison
- Patients with paradoxical psoriasis vs controls without paradoxical reactions
- Outcome
- Paradoxical reactions on biologic therapy
Methodological detailsweb-based registry (TReasure database), multicentre (17 centres)
- Web-based registry (TReasure database)
- Multicentre (17 centres)
Main finding
As reported in the abstract
- Patients who developed paradoxical reactions (PRs)
- 136 (1.66%)
- PRs caused by first biologic agent
- 60%
- Median time from biologic onset to PRs, months (range 1-132; mean 21)
- 12
- Paradoxical psoriasis (PP) as share of PRs
- 92.6%
- PP type: pustular
- 60.3%
- PP type: palmoplantar
- 30.9%
- Agent causing PP: adalimumab
- 30.9%
- Agent causing PP: infliximab
- 19%
- Agent causing PP: etanercept
- 17.4%
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Smoking, PPvs controls (SpA) | 2.0 (1.05–3.81) | P = 0.003 | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | Estimate | P value |
|---|---|---|
| csDMARD use, PP vs RA controls (RA)PP vs Controls · use significantly higher in RA controls than in PP patients | OR (SSZ use) 0.15 | P = 0.033 |
| csDMARD use, PP vs RA controls (RA)PP vs Controls · use significantly higher in RA controls than in PP patients | OR (HCQ use) 0.15 | P = 0.012 |
| csDMARD use, PP vs RA controls (RA)PP vs Controls · use significantly higher in RA controls than in PP patients | OR (LEF use) 0.13 | P = 0.015 |
Management of PP
- Switched biologic agent
- 73.2%
- Switched to TNF inhibitor (TNFi)
- 46.03%
- Switched to non-TNFi
- 26.9%
- Etanercept selected
- 24.6%
- Secukinumab selected
- 9.5%
- Adalimumab selected
- 8.7%
- Progression after switch to another TNFi
- 5.17%
Original publication
The predictors of paradoxical reactions, especially psoriasis, to biologic therapy—findings from the TReasure database: a 5-year follow-up study. Rheumatology (Oxford). Published 24 June 2023. doi:10.
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