Association between biologics use and risk of serious infection in patients with psoriasis

JAMAPenso L, Dray-Spira R, Weill A, et al. | September 17, 2021


In this cohort analysis of people with moderate to severe psoriasis, the risk of serious infections was higher in new users of infliximab and adalimumab compared with etanercept, although ustekinumab users had a decreased risk, but not new users of IL-17 and IL-23 inhibitors or apremilast. Additional observational studies are required to corroborate the findings of the most recent drugs.

  • In total, 44,239 new biologic therapy users were identified (mean [SD] age, 48.4 [13.8] years; 22,866 [51.7%] men; median follow-up, 12 months [interquartile range, 7-24 months]). In total, 29,618 (66.9%) were prescribed a tumor necrosis factor inhibitor first, followed by 6,658 (15.0%) an interleukin (IL) 12/23 inhibitor, 4,093 (9.3%) an IL-17 inhibitor, 526 (1.2%) an IL-23 inhibitor, and 3344 (7.6%) apremilast.

  • There were 1,656 severe infections in total, with a crude incidence rate of 25.0 per 1,000 person-years.

  • Gastrointestinal infections were the most common severe infections.

  • After adjusting for time-dependent covariables, the risk of serious infections was higher for new users of adalimumab or infliximab compared with etanercept, although ustekinumab was linked with a decreased risk of serious infection.

  • The risk of serious infections was not raised for novel IL-17 and IL-23 inhibitors guselkumab or apremilast vs etanercept users.

  • Concurrent use of nonsteroidal anti-inflammatory drugs or systemic corticosteroids enhanced the risk of severe infections.

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