Article Figures & Data
Figures
- Figure 1.
Participant flow diagram. CNO: chronic nonbacterial osteomyelitis; DMARD: disease-modifying antirheumatic drug; IBD: inflammatory bowel disease; JIA: juvenile idiopathic arthritis; TNFi: tumor necrosis factor inhibitor.
- Figure 2.
Incidence rate ratio of new-onset PsO for each TNFi adjusted for covariates using Poisson regression. Covariates included sex, family history of PsO, and exposure to disease-modifying antirheumatic drugs. PsO: psoriasis; TNFi: tumor necrosis factor inhibitor.
Tables
All, n TNFi-unexposed,
n (%)TNFi-exposed,
n (%)Infliximab,
n (%)Etanercept,
n (%)Adalimumab,
n (%)Subjects 5088 3065 2023 1334 304 383 IBDa 3794 2250 (73.4) 1544 (76.3) 1301 (84.3) 0 (0.0) 241 (15.7) JIAa 1189 733 (23.9) 456 (22.6) 23 (5.0) 300 (65.8) 133 (29.2) CNOa 105 82 (2.7) 23 (1.1) 10 (43.5) 4 (17.4) 9 (39.1) Age, yrs, mean (SD) 11.3 (4.7) 11.0 (5.1) 11.8 (4.1) 12.3 (3.5) 9.6 (5.0) 11.8 (4.5) Female 2537 1561 (50.9) 976 (48.2) 581 (43.5) 207 (68.1) 188 (49.1) Race White 3925 2379 (77.6) 1546 (76.4) 1010 (75.7) 238 (78.2) 296 (77.2) Black 469 245 (8.0) 224 (11.1) 161 (12.1) 27 (8.9) 36 (9.4) Other/unknown 693 440 (18.5) 253 (12.5) 163 (12.2) 39 (12.8) 51 (13.3) Obesity 141 102 (3.3) 39 (1.9) 21 (1.6) 12 (3.9) 6 (1.6) Family history of psoriasisb 161 85 (2.8) 76 (3.8) 26 (2.0) 29 (9.5) 21 (5.5) DMARD 968 355 (11.6) 613 (30.3) 280 (21.0) 213 (70.0) 119 (31.1) Certolizumab pegol and golimumab counts reflected in the TNFi-exposed column but not shown as separate TNFI columns due to small sample size.
↵aFor specific TNFi therapy columns, n (%) refers to that of the underlying condition (row).
↵bFirst-degree relative. CNO: chronic noninfectious osteomyelitis; IBD: inflammatory bowel disease; DMARD: disease-modifying antirheumatic drug (including methotrexate, leflunomide, and sulfasalazine); JIA: juvenile idiopathic arthritis; TNFi: tumor necrosis factor inhibitor.
- Table 2.
Follow-up duration, psoriasis cases, and unadjusted incidence rates per 1000 PY for entire cohort and for each underlying disease according to TNFi type and presence of a DMARD.
Any TNFi Group TNFi Only TNFi + DMARD All* IBD JIA All* IBD JIA All* IBD JIA Follow-up, yrs TNFi 6504 4909 1548 3906 3441 434 2598 1468 1114 IFX 4276 4162 93 3029 2981 42 1246 1181 51 ETN 1220 0 1214 296 0 293 924 0 930 ADA 1003 742 240 578 458 99 425 284 171 Psoriasis cases TNFi 91 64 25 58 49 9 33 15 16 IFX 53 51 5 40 40 0 13 11 0 ETN 21 0 21 7 0 7 14 0 17 ADA 17 13 4 11 9 2 6 4 5 Incidence rate per 1000 PY TNFi 14.0 13.0 16.1 14.8 14.2 20.7 12.7 10.2 14.4 IFX 12.4 12.3 0 13.2 13.4 0 10.4 9.3 0 ETN 17.2 – 17.3 23.6 – 23.9 15.2 – 18.3 ADA 16.9 17.5 16.6 19 19.6 20.2 14.1 14.1 29.3 ↵*“All” patients includes those diagnosed with IBD, JIA, or CNO.. ADA: adalimumab; DMARD: disease-modifying antirheumatic drug (including methotrexate, leflunomide, and sulfasalazine); ETN: etanercept; IBD: inflammatory bowel disease; IFX: infliximab; JIA: juvenile idiopathic arthritis; PY: person-year; TNFi: tumor necrosis factor inhibitor.
All IBD JIA Any TNFi group SIR (95% CI) All 34.3 (27.9-42.1) 32.0 (25.0-40.8) 39.6 (26.8-58.6) IFX 30.4 (23.2-39.8) 30.0 (22.8-39.5) 0 ETN 42.2 (27.5-64.7) – 42.4 (27.6-65.0) ADA 41.5 (25.8-66.8) 42.9 (24.9-73.9) 40.8 (15.3-108.6) TNFi only All 36.4 (28.1-47.1) 34.9 (26.4-46.2) 50.8 (26.4-97.6) IFX 32.4 (23.7-44.1) 32.9 (24.1-44.8) 0 ETN 58.0 (27.6-121.6) – 58.6 (27.9-122.8) ADA 46.6 (25.8-84.2) 48.1 (25.0-92.5) 49.4 (12.4-197.7) TNFi + DMARD All 31.1 (22.1-43.8) 25.0 (15.1-41.5) 35.2 (21.6-57.5) IFX 25.6 (14.8-44.0) 22.8 (12.6-41.2) 0 ETN 37.1 (22.0-62.67) – 37.3 (22.1-62.9) ADA 34.6 (15.5-77.0) 34.6 (13.0-92.1) 34.7 (8.7-138.7) SIRs were calculated as the ratio of observed to expected number of psoriasis cases as estimated by the incidence in the general pediatrics population (40.8 per 100,000).24 SIR > 1 indicates that more cases were observed than expected. ADA: adalimumab; DMARD: disease-modifying antirheumatic drug (including methotrexate, leflunomide, and sulfasalazine); ETN: etanercept; IBD: inflammatory bowel disease; IFX: infliximab; JIA: juvenile idiopathic arthritis; TNFi: tumor necrosis factor inhibitor.
