Clinicians should take into account patients’ medications when evaluating new or aggravated psoriasis as numerous reports indicat that some therapies may exacerbate or induce psoriasis, according to research from a study published in the Journal of The American Academy of Dermatology International.

As the prescription landscape is in constant flux with new medications, and established medications with recent increased usage due to COVID-19, researchers sought to investigate medication-related adverse psoriasis events excluding drugs already approved by the US Food and Drug Administration to treat psoriatic arthritis or psoriasis.

To accomplish this, they conducted a retrospective study of the US Food and Drug Administration’s Adverse Event Reporting System from January 2016 through September 2021 that included more than 3000 reports for psoriasis adverse events, most commonly associated with prednisone (674), tocilizumab (513), hydroxychloroquine (437), and dupilumab (376).


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Of all medications reported, prednisone topped the list for being linked to psoriasis adverse events; prednisone may flare psoriasis upon withdrawal. More than 30% of patients with preexisting psoriasis experience exacerbation following antimalarials, it was noted. With hydroxychloroquine prescribed as treatment for COVID-19, reports in 2020 of hydroxychloroquine-related adverse events were 3 to 20 times higher than hydroxychloroquine adverse event reports in each of the previous 4 years. Tocilizumab, a monoclonal antibody prescribed for patients with COVID-19 related pneumonia, saw a similar jump in reports in 2020. Dupilumab, approved in 2017, is emerging in prescription popularity and may continue to climb the list. Only 1 beta-blocker made the top 50 list, metoprolol (97). Lithium, commonly associated with drug-induced psoriasis, had 20 reports, likely due to a lower prescription rate than the other medications on the list.

Study limitations include that the US Food and Drug Administration’s Adverse Event Reporting System database does not establish rates of occurrence, that the existence of a report fails to establish causation between the medication and the adverse event, reporting bias, and unaccounted for confounders.

Researchers concluded that, “this study supports the importance of providers considering patients’ medications when assessing new or worsening psoriasis, in light of the new availability of medications and changing prescription habits.”

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Learned C, Alsukait S, Deverapalli S, et al. Psoriasis adverse events and associated medications as reported in the US Food and Drug Administration’s Adverse Event Reporting System from 2016 to 2021. JAAD Int. Published online April 18, 2022. doi:10.1016/j.jdin.2022.03.010