Elicit: Clinical Outcomes of TNF Inhibition in RA and Psoriasis

Clinical Outcomes of TNF Inhibition in RA and Psoriasis

Identify clinical evidence linking TNF inhibition to outcomes in rheumatoid arthritis and psoriasis

Abstract

TNF inhibitors demonstrate substantial therapeutic efficacy for psoriatic arthritis and psoriasis, with 37% of csDMARD-inadequate responders achieving clinical improvement (ACR50) versus 8% with placebo (RR 5.63, 95% CI 3.98 to 7.96). For moderate-to-severe plaque psoriasis, PASI 75 response rates reach 80-91% with infliximab compared to 3% with placebo, with therapeutic effects appearing within 4 weeks. However, paradoxical new-onset or worsening psoriasis emerges as a recognized adverse event in patients receiving TNF inhibitors for rheumatoid arthritis, occurring at 1.04 per 1000 person-years compared to 0 per 1000 person-years with traditional DMARDs. Adalimumab shows 4.6-fold higher incidence of paradoxical psoriasis than etanercept and 3.5-fold higher than infliximab, though no statistically significant differences in therapeutic effectiveness exist among anti-TNF agents. Most patients (66%) developing paradoxical psoriasis can continue TNF inhibitor therapy with concurrent psoriasis treatment, balancing control of the primary indication against induced skin disease.

Methods

We analyzed 10 sources from an initial pool of 200, using 8 screening criteria. Each paper was reviewed for 8 key aspects that mattered most to the research question.

Paper search

We performed a semantic search across over 138 million academic papers from the Elicit search engine, which includes all of Semantic Scholar and OpenAlex. We ran a query to find studies linking TNF inhibition to outcomes in rheumatoid arthritis and psoriasis, retrieving 200 papers for screening.

Screening

We screened in sources based on their abstracts that met criteria related to target population, intervention type, clinical outcomes, study design, and more.

Results

Characteristics of Included Studies

The review included 10 studies published between 2000 and 2025, comprising 5 randomized controlled trials, 3 meta-analyses/systematic reviews, 1 prospective registry study, and 1 retrospective cohort study.

Study	Full text retrieved?	Study Type	Target Condition	TNF Inhibitor(s)	Sample Size	Primary Outcomes
L. Lemos et al., 2014	No	Systematic review and meta-analysis	Psoriatic arthritis	Adalimumab, etanercept, golimumab, infliximab	Not mentioned	ACR20, ACR50, PsARC, PASI75
G. Cagnotto et al., 2025	No	Systematic review and meta-analysis of RCTs	Psoriatic arthritis	TNFi (specific agents not mentioned)	7857	ACR50, HAQ, SF-36 MCS, Sharp/Van der Heijde-PsA
E. Shmidt et al., 2012	No	Retrospective cohort study	Psoriasis as adverse event	Infliximab, adalimumab, etanercept	56	Complete or partial response
Mark Harrison et al., 2008	Yes	Prospective observational cohort (registry)	Rheumatoid arthritis; psoriasis as adverse event	Etanercept, infliximab, adalimumab	9826 anti-TNF, 2880 DMARD	Incidence of new-onset psoriasis
Angelique N. Collamer & D. Battafarano, 2010	No	Systematic literature review	Psoriasis as adverse event	Infliximab, adalimumab, etanercept	207	Not mentioned
P. Mease et al., 2000	No	Randomized controlled trial	Psoriatic arthritis and psoriasis	Etanercept 25 mg twice-weekly subcutaneous	60	PsARC, ACR20, PASI
N. Bansback et al., 2009	No	Systematic review and meta-analysis	Psoriasis	Infliximab, adalimumab, etanercept	Not mentioned	PASI
U. Chaudhari et al., 2001	No	Randomized controlled trial	Psoriasis	Infliximab 5 mg/kg and 10 mg/kg intravenous	33	Physician’s Global Assessment
K. Reich et al., 2005	No	Randomized controlled trial	Psoriasis	Infliximab 5 mg/kg via infusion	378	PASI
K. Thorlund et al., 2012	No	Indirect comparison meta-analysis	Psoriatic arthritis	Adalimumab, etanercept, golimumab, infliximab	Not mentioned	PsARC, HAQ, PASI

Efficacy in Psoriatic Arthritis

TNF inhibitors demonstrated substantial clinical benefit in psoriatic arthritis with significant improvements in clinical response at 12 weeks, as well as enhanced physical function and health-related quality of life metrics compared to placebo.

Efficacy in Psoriasis

TNF inhibitors displayed high efficacy for moderate-to-severe plaque psoriasis, varying in potency among agents. A mixed-treatment comparison meta-analysis indicated significant response rates for PASI 75 across different TNF inhibitors.

Safety Profile

The safety profile of TNF inhibitors showed a favorable outcome, although paradoxical reactions, such as new-onset psoriasis, were observed in patients treated for rheumatoid arthritis and other inflammatory conditions.

Synthesis

Evidence reveals an apparent paradox: while TNF inhibitors are effective in treating psoriatic arthritis and psoriasis, they can also induce or exacerbate psoriasis in certain patients. This duality in treatment effect may relate to unique immune response mechanisms.

Study Limitations

Sample sizes, follow-up duration, and potential biases could affect the interpretation of TNF inhibition evidence, revealing the need for more extensive data on long-term outcomes.