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Low Serious Infection Risk with Newer Agents in Psoriasis

JAMA Dermatology reports on a comparative cohort study of 107,707 psoriasis patients, finding a decreased risk of serious infections among users of apremilast, etanercept, and ustekinumab when compared with methotrexate.

Claims-\based, observational cohort study from 2 large US health insurance databases (Optum and MarketScan; 2003-2015) examined psoriasis patients who were new users of systemic medications for psoriasis. Pairwise propensity score matching was used to adjust for potential confounders.

Two different commercial claims datasets included 31,595 and 76,112 psoriasis patients who were new users of acitretin, adalimumab, apremilast, etanercept, infliximab, methotrexate, and ustekinumab. Users of acitretin, apremilast, infliximab, and methotrexate were older and had higher baseline comorbidity scores than subcutaneous biologic users (adalimumab, etanercept, and ustekinumab).

Overall, the serious infection incidence rates were low, ranging from 1.1-1.3/100 Pt-yrs in the Marketscan database to 1.4-1.4/100 Pt-yrs in the Optum database. 

Pooled analyses compared the (SIE) rates for each cohort compared to those taking methotrexate and found the following SIE rates (expressed as hazard ratio [HR]; and 95% confidence intervals):

  • apremilast HR=0.50; 0.26-0.94
  • Etanercept HR=0.75; 0.61-0.93
  • Ustekinumab HR=0.65; 0.47-0.89
  • NO difference in SIE for acitretin, adalimumab, infliximab compared with methotrexate
  • Acetretin showed a a significantly increased risk of cellulitis (HR=1.76; 1.11-2.80)

Psoriasis patients have a relatively low risk of SIE with the use of current therapies, with a small but signicant advantage for apremilast, etanercept, and ustekinumab treated psoriasis patients.

The author has no conflicts of interest to disclose related to this subject

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