# 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.

### Methods

We analyzed 10 sources from an initial pool of 200, using 8 screening criteria. More on methods

## Paper Search

We performed a semantic search across over 138 million academic papers from the Elicit search engine. The search returned 200 total results for screening.

## Screening

We screened in sources based on their abstracts that met these criteria:

- **Target Population - Disease**: Does the study include patients diagnosed with rheumatoid arthritis and/or psoriasis?
- **Intervention Type**: Does the study involve TNF inhibitor therapy?
- **Clinical Outcomes**: Does the study report clinical outcomes such as disease activity measures, symptom improvement?
- **Study Design**: Is the study design a randomized controlled trial, cohort study, etc.?
- **Population Age**: Does the study population include adult patients (≥18 years of age)?
- **Study Type - Human Research**: Is this a study conducted in human participants?
- **Sample Size Adequacy**: Does the study include 10 or more patients?
- **Publication Type**: Is this a full-text article?

## Data Extraction

We asked a large language model to extract each data column from each paper, including key findings about the link between TNF inhibition and clinical outcomes, safety findings, and limitations.

## Results

### Characteristics of Included Studies
The review included 10 studies published between 2000 and 2025, comprising randomized controlled trials and systematic reviews.

| Study | Year | Type | Target Condition | TNF Inhibitor(s) | Sample Size | Primary Outcomes |
|-------|------|------|------------------|-------------------|-------------|------------------|
| L. Lemos et al. | 2014 | Systematic Review | Psoriatic Arthritis | Adalimumab, etanercept, golimumab, infliximab | Not mentioned | ACR20, ACR50, PASI75 |
| G. Cagnotto et al. | 2025 | Meta-Analysis | Psoriatic Arthritis | TNFi | 7857 | ACR50, HAQ, SF-36 MCS |  
| E. Shmidt et al. | 2012 | Retrospective Cohort | Psoriasis as Adverse Event | Infliximab, adalimumab, etanercept | 56 | Complete or Partial Response |
| Mark Harrison et al. | 2008 | Prospective Observational | RA; Psoriasis as Adverse Event | Etanercept, infliximab, adalimumab | 9826 | Incidence of New-Onset Psoriasis |
| Angelique N. Collamer & D. Battafarano | 2010 | Literature Review | Psoriasis as Adverse Event | Infliximab, adalimumab, etanercept | 207 | Not mentioned |
| P. Mease et al. | 2000 | Randomized Controlled Trial | Psoriatic Arthritis | Etanercept | 60 | PsARC, ACR20, PASI |
| N. Bansback et al. | 2009 | Meta-Analysis | Psoriasis | Infliximab, adalimumab, etanercept | Not mentioned | PASI |
| U. Chaudhari et al. | 2001 | RCT | Psoriasis | Infliximab | 33 | Physician’s Global Assessment |
| K. Reich et al. | 2005 | RCT | Psoriasis | Infliximab | 378 | PASI |
| K. Thorlund et al. | 2012 | Meta-Analysis | Psoriatic Arthritis | Adalimumab, etanercept, golimumab, infliximab | Not mentioned | PsARC, HAQ, PASI |

### Effects of TNF Inhibitors
#### Efficacy in Psoriatic Arthritis

TNF inhibitors produced large improvements in clinical response at 12 weeks compared to placebo. Physical function and health-related quality of life improved with significant results. TNFi also reduced radiographic progression.

#### Efficacy in Psoriasis

For moderate-to-severe plaque psoriasis, TNF inhibitors showed high efficacy, with infliximab achieving PASI 75 in the majority of patients.

### Safety Profile

The safety profile of TNF inhibitors appeared favorable overall, though paradoxical new-onset psoriasis remains a recognized adverse event in patients treated for other indications. Incidence rates differ by agent and patient population.

### Synthesis

The evidence reveals that TNF inhibitors effectively treat both psoriatic arthritis and moderate-to-severe psoriasis while presenting challenges related to paradoxical psoriasis development. Properties of TNF in relation to immune response play a vital role in these contrasting outcomes.

### References

1. E. Shmidt et al., 2012 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-205506173/index.html)
2. Mark Harrison et al., 2008 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-17483483/index.html)
3. Angelique N. Collamer et al., 2010 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-36617229/index.html)
4. P. Mease et al., 2000 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-9392760/index.html)
5. N. Bansback et al., 2009 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-8784208/index.html)
6. U. Chaudhari et al., 2001 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-37552506/index.html)
7. K. Reich et al., 2005 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-7857781/index.html)
8. K. Thorlund et al., 2012 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-3242645/index.html)
9. L. Lemos et al., 2014 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-26935205/index.html)
10. G. Cagnotto et al., 2025 - [Link](/content/review/5a2e0186-285a-4c74-99cd-dd6eb1fbe77d/source/ss-276315917/index.html)