The therapeutic potential of TNF-α antagonists for skin psoriasis comorbidities

IMPORTANCE OF THE FIELD: Alopecia, psoriatic arthritis, the metabolic syndrome, inflammatory bowel diseases and cardiovascular diseases may occur as skin psoriatic comorbidities. TNF-alpha antagonists are used to treat psoriasis. Adalimumab is one of the recognized active agents for this indication. AREAS COVERED IN THIS REVIEW: The current peer-reviewed publications and presentation of original findings. WHAT THE READER WILL GAIN: Adalimumab is active on recalcitrant psoriasis and some of its comorbidities, particularly arthropathies and Crohn's disease. However, the progression of the radiological alterations is limited with regression of the bony erosions. Psoriatic enthesopathy also regresses. Mortality associated with psoriasis arthropathy is on the decline. Crohn's disease, the most frequent inflammatory bowel comorbidity of psoriasis, is responsive to adalimumab. The effect of adalimumab on the metabolic syndrome and cardiovascular involvement is more erratic. The spectacular effects of adalimumab may be associated with some adverse effects. In particular, despite a marked reduction in the psoriasis area-and-severity index (PASI) score some new acute lesions of cutaneous psoriasis may develop corresponding to paradoxical psoriasis. Other potential adverse effects include infections, granulomas, rapid growth of cancers and occurrence of lymphomas. TAKE HOME MESSAGE: Adalimumab frequently controls moderate-to-severe forms of cutaneous psoriasis and some of its comorbidities.