Systematic review of TNF alpha-induced paradoxical psoriasis: Treatment outcomes of switching to alternative biologic therapies in inflammatory bowel disease patients

Objectives: The objective of this systematic review was to evaluate the efficacies of different biologic therapies in treating tumor necrosis factor-alpha (TNF alpha)-induced paradoxical psoriasis (PXP) and controlling inflammatory bowel disease (IBD) symptoms. Methods: We conducted a literature search of the Ovid EMBASE, Ovid Medline, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases from their inception to October 3, 2021. We considered all peer-reviewed, randomized controlled trials, chart reviews, and observational studies that discussed the TNF alpha-induced PXP treatment outcomes in IBD patients of switching to different biologic therapies. Results: Switching to ustekinumab (UST) resulted in complete or partial resolution of TNF alpha-induced PXP in 83.1% of patients (74 out of 89 patients), while switching to either vedolizumab (VDZ) or secukinumab led to complete resolution in 100% of patients (eight out of eight patients). Approximately 75.4% of patients who were switched to UST remained in IBD remission, 4.6% in partial remission, and 20.0% in the flare of IBD. Conclusions: UST has sufficient data to demonstrate the efficacy in treating TNF alpha-induced PXP and controlling IBD symptoms concurrently. More data is needed to validate the efficacies of VDZ and SEC in treating TNF alpha-induced PXP in IBD patients.