TNFi Treatment Not Associated for Increased Risk for Respiratory Tract Infection

Psoriasis on elbow
Psoriasis on elbow
The risk for respiratory tract infections associated with treatment with tumor necrosis factor inhibitors for psoriasis was assessed.

No increased risk for respiratory tract infections (RTI) in patients receiving tumor necrosis factor inhibitors (TNFis) for psoriasis was found, according to   study results published in the Journal of the American Academy of Dermatology. Although immune-targeted therapies should be undertaken with caution during the coronavirus disease (COVID-19) pandemic, anti-TNF therapy does not appear to potentiate respiratory infection.

Data were extracted from phase 3 placebo-controlled trials assessing TNFi treatment for psoriasis. Studied therapies included adalimumab, infliximab, etanercept, and certolizumab. Data on adverse events were extracted and pooled. Meta-estimates on the risk for RTIs were reported as odds ratios (ORs).

Overall, the risk for RTI was not significantly increased in the pooled TNFi group compared with the placebo group (OR, 1.08; 95% CI, 0.84-1.38; P =.55). This trend persisted in analyses stratified by mechanism of action, drug structure, and dosing. Even certolizumab, the most recently introduced TNFi, was not associated with increased risk for RTI vs placebo (OR, 1.18; 95% CI, 0.50-2.79; P =.70), the investigators noted.

Although analyses showed no increased risk for RTI in patients using TNFi, between-study heterogeneity may limit the reliability of these results. In addition, results should be extrapolated with caution; other biologic agents targeting interleukin (IL)-17 and IL-23 may have different risk profiles than TNFi. ‘Trial data and large scale, prospective 85 cohort studies are urgently needed to better define the impact of TNFi on infections…from COVID-19 illness,” investigators wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry.

Please see the original reference for a full list of authors’ disclosures.


Syed MN, Shah M, Shin DB, Wan MT, Winthrop KL, Gelfand JM. Effect of anti-tumor necrosis factor therapy on the risk of respiratory tract infections and related symptoms in psoriasis patients – a meta-estimate of pivotal phase 3 trials relevant to decision-making during the COVID-19 pandemic [published online August 26, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.08.095