Risk of Infection in Psoriasis Lower with Some Biologics

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Psoriasis patients have a lower risk of serious infection with specific biologic and non-biologic medications than with methotrexate, based on new research results.

According to a study published in JAMA Dermatology , patients who are new recipients of apremilast, etanercept, and ustekinumam face a lower rates of serious infection compared to patients receiving traditional methotrexate therapy.

“We found significant differences in the risk of serious infection across different systemic treatments for psoriasis,” said study author Erica D. Dommasch, M.D., MPH, dermatology instructor at Beth Israel Deaconess Medical Center. “This information should be considered when prescribing therapies for individual patients, as well as future treatment algorithms.”

In the largest observational study to date, investigators analyzed medical and outpatient pharmacy claims of 107,707 patients from two large U.S. health insurance databases from 2003 to 2015. They reviewed outcomes associated with acitretin, adalimumab, apremilast, etanercept, infliximab, methotrexate, and ustekinumab. At treatment initiation, patients receiving acitretin, apremilast, infliximab, and methotrexate were older and had higher baseline co-morbidities than those receiving the subcutaneous biologics - adalimumab, etanercept, and ustekinumab.

For all therapies, the most frequently occurring serious infections, in order of frequency, were cellulitis, pneumonia, and bacteremia/sepsis.

Based on results, researchers identified a statistically significant decreased rate of overall serious infection among patients receiving apremilast, etanercept, and ustekinumab compared to those receiving methotrexate. In particular, they pinpointed a significantly decreased serious infection risk with new apremilast users. They also discovered a lower rate of bacterermia/sepsis in etanercept users, as well as a decreased pneumonia rate with ustekinumab recipients.

Conversely, acitretin, adalimumab, and infliximab didn’t present different risks from methotrexate. Among the three medications, though, infliximab carried a significantly increased serious infection rate compared to adalimumab. Acitretin also presented a significantly increased risk of cellulitis compared to methotrexate.

The lowered infection risk with etanercept-but not adalimumab or infliximab-could be attributed to a dosing effect, researchers postulated. Additionally, ustekinumab’s reduced infection risk suggests it is less broadly immunosuppressive

Ultimately, the investigators said, because of the study’s patient participant size, the results are generalizable to real-world practice in the United States.

REFERENCES

Dommasch E, Kim S, Lee M, Gagne J, Risk of Serious Infection in Patients Receiving Systemic Medications for the Treatment of Psoriasis. JAMA Dermatology (2019), doi: 10.1001/jamadermatol.2019.1121