The Riskiest Medication for Psoriasis: Certolizumab Pegol, According to Study
By: Jhoser Bermúdez Guerrero
October 25, 2023
Rheumatoid arthritis, a systemic autoimmune disease characterized by joint stiffness and pain, is commonly treated with disease-modifying drugs (DMARDs), as reported by specialized portal Medscape. Traditionally, synthetic drugs like methotrexate and sulfasalazine were used; however, a wide variety of biological or targeted synthetic drugs have emerged, improving the prognosis for many patients. However, these newer medications come with potential adverse effects.
Disease-modifying antirheumatic drugs (DMARDs) are responsible for preventing joint damage and disability induced by various chronic inflammatory rheumatic diseases, such as rheumatoid arthritis, psoriatic arthritis, and disseminated lupus erythematosus. On the other hand, tumor necrosis factor inhibitors are medications used to treat inflammatory conditions like rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and inflammatory bowel disease.
Despite tumor necrosis factor inhibitors’ effectiveness in treating rheumatoid arthritis, their relationship with psoriasis presents a paradox. It is paradoxical that these inhibitors’ adverse effect is the appearance or worsening of psoriasis in patients with rheumatoid arthritis. A hypothesis explaining this reaction suggests that blocking the tumor necrosis factor inhibitor leads to an absence of downregulation of alpha interferon in plasmacytoid cells, which has been associated with an increased risk of psoriasis.
A group of researchers systematically analyzed the relationship between tumor necrosis factor inhibitors and psoriasis by collecting information from the United States Food and Drug Administration (FDA). Their study consisted of reports focused on monotherapy with a tumor necrosis factor inhibitor, methotrexate, or disease-modifying drugs for treating rheumatoid arthritis as the only indication. The researchers calculated the reporting odds ratio for psoriasis compared to methotrexate and found that tumor necrosis factor inhibitors presented a higher risk of psoriasis.
The analysis included 112,410 reports of adverse events with tumor necrosis factor inhibitors and 6,142 with methotrexate. The study revealed that the frequency of psoriasis as an adverse effect was 0.11%. In comparison, psoriasis associated with tumor necrosis factor inhibitors was reported from 0.29% to 1.9%, with certolizumab pegol having the highest frequency (1.9%) followed by adalimumab (1.16%).
The study’s authors concluded that certolizumab pegol had a statistically significant association with adverse events of psoriasis compared to other rheumatoid arthritis drugs, even when compared to the second agent with the highest association, adalimumab. Therefore, tumor necrosis factor inhibitors, particularly certolizumab pegol, increase the risk of psoriasis in patients with rheumatoid arthritis. It is important for patients to carefully weigh the risks and benefits of treatments, especially those with a history of psoriasis or affected family members, and make informed and personalized decisions.
Expert opinion from Dr. Javier Merayo Chalico, a rheumatologist, supports the importance of considering individual risks and benefits when treating patients with rheumatoid arthritis. Dr. Chalico emphasizes the need for precision therapies in these cases.
Source consulted here.