Biologic Use and the Risk of Serious Infection in Psoriasis Patients Save

National Health Data from France examined biologic use in patients with moderate to severe psoriasis, and found the risk of serious infections (SIE) to be increased with some biologics (infliximab and adalimumab), but not others (etanercept, ustekinumab IL-17 and IL-23 inhibitors or apremilast). 

The psoriasis cohort was derived from the French National Health Data System and included adult psoriasis patients initiating biologic agents or apremilast between 2008-2019. Biologics under study included adalimumab, infliximab, etanercept, ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and apremilast. The SIE risk was also examined in those on nonsteroidal anti-inflammatory drugs or systemic corticosteroids.

The cohort included a total of 44 239 new drug (biologic) starts; the mean age was 48.4 yrs. and 52% were men; with a median follow-up of 12 months. Most (67%) started on a TNF inhibitor first, followed by 15% on ustekinumab, 9% on an IL-17 inhibitor, 1.2% IL-23 inhibitor, and 7.6% apremilast.

There were a total of 1656 serious infections; with a crude incidence rate was 25.0 per 1000 person-years (2.5/100PYs). Most common SIEs were were gastrointestinal infections (39%). After adjustments, the significant findings in these serious infection rates:

• Higher for adalimumab (HR, 1.22) or infliximab (HR 1.79) compared to etanercept
• Lower risk of SIE with ustekinumab (HR 0.79) vs. etanercept
• Compared to etanercept, the SIE risk was not increased for IL-17 inhibitors, guselkumab (IL-23 inhibitor) or apremilast
• Overall a higher risk of serious infections seen with concomitant nonsteroidal anti-inflammatory drugs or systemic corticosteroids.

Overall, the use of biologics in patients with moderate to severe psoriasis was associated with a low risk of serious infections, but amongst these, infliximab and adalimumab had a significantly greater number of serious infections.