S1894 A Multicenter Study Identifying the Risk of Psoriasis in Patients with Inflammatory Bowel Disease Treated with TNF-α Inhibitors

Introduction: Tumor necrosis factor-alpha (TNF-α) inhibitors are widely used in the treatment of inflammatory bowel disease (IBD), with proven efficacy in achieving and maintaining remission. However, these agents have been implicated in paradoxical immune-mediated adverse effects, including psoriasis. This study aimed to quantify the risk of incident psoriasis and psoriatic arthritis in patients with IBD receiving TNF-α inhibitor. Methods: We conducted a retrospective cohort study using the TriNetX research network, identifying adult patients with IBD who initiated treatment with either TNF-α inhibitors or non–TNF-α-based treatments. Propensity score matching (1:1) was applied to balance baseline characteristics, including age, sex, comorbidities, and IBD subtype. The primary outcome was a new diagnosis of psoriasis or psoriatic arthritis within 5 years of treatment initiation. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards models. Results: A total of 11,663 IBD patients treated with TNF-α inhibitors were compared to 53,977 patients receiving non–TNF-α therapies. After matching, 11,076 patients remained in each group with well-balanced characteristics. TNF-α inhibitor use was associated with a significantly increased risk of psoriasis or psoriatic arthritis (aHR 1.63; 95% CI, 1.35–1.98; P < 0.001). Subgroup analysis revealed significantly higher risk among females (aHR 1.90; 95% CI, 1.45–2.48; P < 0.001), while no significant association was seen in males (aHR 1.16; 95% CI, 0.85–1.58; P = 0.354). The greatest risk was observed in patients aged >60 years (aHR 2.56; 95% CI, 1.58–4.15; P < 0.001). Among individual agents, infliximab (aHR 1.53; 95% CI, 1.16–2.03; P = 0.003) and adalimumab (aHR 1.45; 95% CI, 1.09–1.92; P = 0.010) were both associated with elevated risk. Upon stratification, both psoriasis (aHR 1.77; 95% CI, 1.46–2.14; P < 0.001) and psoriatic arthritis (aHR 1.54; 95% CI, 1.01–2.36; P = 0.048) showed significantly increased incidence in the TNF-α group. Conclusion: In this study, TNF-α inhibitor therapy was associated with a significantly increased risk of new-onset psoriasis and psoriatic arthritis in patients with IBD. These findings underscore the importance of surveillance for paradoxical inflammatory manifestations and support individualized treatment decision-making in IBD management. Further studies are needed to better understand the mechanisms and inform strategies to minimize risk.