Systematic review of TNFα-induced paradoxical psoriasis: Treatment outcomes of switching to alternative biologic therapies in inflammatory bowel disease patients

Figures & data

Figure 1. PRISMA flow diagram for systematic review. PRISMA: preferred reporting items for systematic reviews and meta-analyses.

Table 1. Quality appraisal of included studies.^a

	Adequate description of IBD presentation	Accurate diagnosis of psoriasiform reaction	Convincing evidence in support of psoriasiform reaction	Alternate explanations were considered and refuted
Boggs et al. (5)	Yes	Yes	Yes	Yes
Dolinger et al. (6)	Yes	Yes	No	No
Eickstaedt et al. (7)	Yes	Partial	Yes	Yes
Ezzedine et al. (4)	Yes	Yes	Yes	Yes
George et al. (8)	Yes	Yes	Yes	Partial
Gold et al. (9)	Partial	Yes	Partial	No
Guerra et al. (10)	Yes	Yes	Yes	Partial
Hirsch et al. (11)	Yes	Yes	Yes	Yes
Kodama et al. (12)	Yes	Yes	Yes	Yes
Olbjorn et al. (13)	Yes	Yes	Yes	Partial
Pijls et al. (14)	Yes	Partial	Yes	Yes
Prieto et al. (15)	Partial	Yes	Partial	No
Pugliese et al. (16)	Yes	Yes	Yes	Yes
Sahuquillo-Torralba et al. (17)	Yes	Yes	Yes	Yes
Santos et al. (18)	Yes	Yes	Partial	No
Tillack et al. (1)	Yes	Yes	Yes	Yes
White et al. (19)	Yes	Yes	Yes	Partial

IBD: inflammatory bowel disease.

^aUsing modified criteria for systematic reviews involving case reports (3).

Table 2. Anti-TNF treatments most likely to lead to a psoriasiform reaction.

Anti-TNF inhibitor causing psoriasiform reactions (% out of all psoriasiform reactions reported in the included studies)					Switched to second anti-TNF after psoriasiform reaction	Improvement of anti-TNF psoriasiform reaction
ADA − 151/380 (39.7%)	IFX − 222/380 (58.4%)	CZP − 6/380 (1.6%)	GOL − 0/380 (0%)	ETA − 1/380 (0.3%)	56/380	22/56 (39.2%)

Anti-TNF: anti-tumor necrosis factor; ADA: adalimumab; IFX: infliximab; CZP: certolizumab pegol; GOL: golimumab; ETA: etanercept.

Table 3. Resolution of anti-TNF-induced psoriasiform reaction and status of IBD upon treatment with alternative biologic therapy.

Drug name	Total cases, n = 97	Complete resolution of psoriasiform reaction (%)	Partial resolution of psoriasiform reaction (%)	No resolution (%)	Time (months) to resolution with new biologic treatment, mean (STDEV), n = 56^a	IBD data reported, n = 70	IBD remission	IBD partial	IBD flare
UST	89	64/89 (71.9%)	10/89 (11.2%)	15/89 (16.9%)	7.29 (5.94–8.64)	65/89	49/65 (75.4%)	3/65 (4.6%)	13/65 (20.0%)
VDZ	6	6/6 (100%)	0 (0%)	0 (0%)		5/6	4/5 (80.0%)	0 (0%)	1/5 (20.0%)
SEC	2	2/2 (100%)	0 (0%)	0 (0%)		0/2	N/A	N/A	N/A

Anti-TNF: anti-tumor necrosis factor; IBD: inflammatory bowel disease; UST: ustekinumab; VDZ: vedolizumab; SEC: secukinumab; N/A: not applicable.

^aTime to resolution was reported in 56 out of 97 patients.

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