P5341 - A Multicenter Study Identifying the Risk of Psoriasis in Patients with Inflammatory Bowel Disease Treated with TNF-α Inhibitors

Omar Al Ta’ani, MD¹, Jana G. Hashash, MD, MSc, FACG², Yahya Alhalalmeh, MD³, Zain Al Ta'ani, MD⁴, Francis A.. Farraye, MD, MSc, MACG², Saqr Alsakarneh, MD, MSc⁵
1Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA, Pittsburgh, PA; 2Mayo Clinic, Jacksonville, FL; 3New York Medical College - Saint Michael's Medical Center, Newark, NJ; 4University of Jordan, Amman, 'Amman, Jordan; 5Mayo Clinic, Rochester, MN

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 five 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 (Table 1). 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, as shown in Figure 1

Discussion: 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


Figure: Table 1. Baseline characteristics for patients who have IBD with TNFi medication or other IBD medication before and after propensity score
matching.


Figure: Figure 1. Adjusted Hazard Ratios for New-Onset Psoriasis and Psoriatic Arthritis Among Patients with IBD

Disclosures:
Omar Al Ta’ani indicated no relevant financial relationships.
Jana Hashash: BMS – Ad Board.
Yahya Alhalalmeh indicated no relevant financial relationships.
Zain Al Ta'ani indicated no relevant financial relationships.
Francis Farraye: Astellas – Advisory Committee/Board Member. Avalo – Advisory Committee/Board Member. Bausch – Advisory Committee/Board Member. BMS – Advisory Committee/Board Member. Braintree Labs – Advisory Committee/Board Member. Fresenius Kabi – Advisory Committee/Board Member. GI Reviewers – Independent Contractor. IBD Educational Group – Independent Contractor. Iterative Health – Advisory Committee/Board Member, Stock Options. Janssen – Advisory Committee/Board Member. Lilly – DSMB. Pfizer – Advisory Committee/Board Member. Pharmacosmos – Advisory Committee/Board Member. Sandoz – Advisory Committee/Board Member. Viatris – Advisory Committee/Board Member.
Saqr Alsakarneh indicated no relevant financial relationships.

Omar Al Ta’ani, MD¹, Jana G. Hashash, MD, MSc, FACG², Yahya Alhalalmeh, MD³, Zain Al Ta'ani, MD⁴, Francis A.. Farraye, MD, MSc, MACG², Saqr Alsakarneh, MD, MSc⁵. P5341 - A Multicenter Study Identifying the Risk of Psoriasis in Patients with Inflammatory Bowel Disease Treated with TNF-α Inhibitors, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.