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Safety and Tolerability of Tumor Necrosis Factor-α Inhibitors in Psoriasis: A Narrative Review

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Abstract

Tumor necrosis factor (TNF)-α inhibitors are an alternative to oral systemic therapies for psoriasis. Data regarding the safety of TNF-α inhibitors from randomized clinical trials may not fully reflect the effects on the clinic patient population receiving the therapy, but other sources of information are available. We performed a literature review to assess the safety and tolerability of the treatment of moderate-to-severe plaque psoriasis with TNF-α inhibitors. A literature search was conducted using PubMed for articles dating from January 2000 to October 2013. Randomized controlled, cohort, open-label, and observational studies were included, as well as case reports and letters to the editor. Articles found on PubMed describing the safety of anti-TNF-α therapy in psoriasis patients were included, while studies highlighting interleukin (IL)-12 and IL-23 inhibitors were excluded, as were non-English articles. In total, 58 articles were included in the review. TNF-α inhibitors exhibit both efficacy and tolerability in patients with moderate-to-severe plaque psoriasis. Adverse effects associated with these medications are not common and can be minimized with routine clinical monitoring and patient education. While the risk of severe adverse events is low, the lack of very large, long-term, randomized safety trials limits the ability to fully define the safety of these agents. TNF-α inhibitors have a good efficacy/safety ratio for use in patients with moderate-to-severe psoriasis. Serious adverse effects are not common, and common injection-site reactions are usually manageable. The benefits of TNF-α inhibitors outweigh the risks for moderate-to-severe psoriasis; however, there are potential adverse effects and the patient populations at highest risk include the elderly and those with a history of malignancy.

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Conflicts and Acknowledgments

The Center for Dermatology Research is supported by an unrestricted educational grant from Galderma Laboratories, L.P. Dr. Feldman is a consultant and speaker for Galderma, Stiefel/GlaxoSmithKline, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, and Bristol Myers Squibb. Dr. Feldman has received grants from Galderma, Astellas, Abbott Labs, Warner Chilcott, Janssen, Amgen, Photomedex, Genentech, BiogenIdec, Coria/Valeant, Pharmaderm, Ortho Pharmaceuticals, Aventis Pharmaceuticals, Roche Dermatology, 3M, Bristol Myers Squibb, Stiefel/GlaxoSmithKline, Novartis, Medicis, Leo, HanAll Pharmaceuticals, Celgene, Basilea, and Anacor, and has received stock options from Photomedex. Ms. Semble and Mr. Davis have no conflicts to disclose.

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Authors and Affiliations

  1. Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA

    Ashley L. Semble, Scott A. Davis & Steven R. Feldman

  2. Center for Dermatology Research, Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Steven R. Feldman

  3. Center for Dermatology Research, Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Steven R. Feldman

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  1. Ashley L. Semble
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Correspondence to Scott A. Davis.

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Semble, A.L., Davis, S.A. & Feldman, S.R. Safety and Tolerability of Tumor Necrosis Factor-α Inhibitors in Psoriasis: A Narrative Review. Am J Clin Dermatol 15, 37–43 (2014). https://doi.org/10.1007/s40257-013-0053-5

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