Monday, 20 May 2019

You are here

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.

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

Add new comment

More Like This

Skyrizi (risankizumab) FDA Approved for Psoriasis

AbbVie has announced that the US FDA has granted the approval of Skyrizi (risankizumab-rzaa) for the treatment of moderate to severe plaque psoriasis. 

Skyrizi is an interleukin-23 (IL-23) inhibitor that was also recently approved in Canada and Japan. Skyrizi is the third IL-23 inhibitor (behind guselkumab [Tremfya] and tildrakizumab [Ilumya]) to be approved in the last year.

Higher Comorbidities in Hidradenitis Suppurativa

JAMA Dermatology reports that patients with hidradenitis suppurativa have significantly more comorbidities than do patients with psoriasis.

A cross-sectional study compared 5306 HS patients, 14 037 patients with psoriasis, and 1 733 810 controls from electronic health records between 2013 and 2018. Specifically they examined comorbidities using the Charlson Comorbidity Index (CCI) score.

Biologic Agents have Equal Efficacy in Enthesitis and Dactylitis

A systematic review has shown that TNF inhibitors (TNFi) are equaled in efficacy by other biologic agents (ustekinumab, secukinumab, and ixekizumab) in psoriatic arthritis (PsA) patients with in dactylitis and enthesitis.

The literature review analyzed datafrom randomized controlled trials (RCTs) with TNFi (infliximab, golimumab, adalimumab), antiinterleukin- 12/23 (ustekinumab) and anti-interleukin-17 (secukinumab, ixekizumab).

Dual IL-17 Inhibitor in Psoriasis Succeeds

Patients with moderate-to-severe plaque psoriasis attained durable complete and near-complete responses for more than a year with a dual inhibitor of interleukin (IL)-17, data from a randomized trial showed. 

AAD/NPF Guidelines on Biologic Use in Psoriasis

Menter and colleagues from the American Academy of Dermatology (AAD) and National Psoriasis Foundation (NPF) have published their expert consensus guidelines for the use of biologics in psoriasis.