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Biologic agents up risk of serious infections in patients with psoriasis

02 Nov 2017

Treatment with biologic agents appears to increase the rate of skin and soft tissue infections among patients with psoriasis, reports a recent study. In addition, a signal exists suggesting a heightened risk for meningitis.

The authors identified a total of 5,889 adult Kaiser Permanente Northern California health plan members with psoriasis who had ever been treated with systemic therapies to estimate the serious infection rate with biologic vs nonbiologic systemic agents. Incidence rates and 95 percent confidence intervals (CIs) were calculated over 29,717 person-years of follow-up. Cox regression was used to calculate adjusted hazard ratios (aHRs).

After adjusting for age, sex, race or ethnicity, and comorbidities, patients treated with biologics had a significantly increased risk for overall serious infection compared with those treated with nonbiologics (aHR, 1.31; 95 percent CI, 1.02 to 1.68). In addition, there was a significantly increased risk for skin and soft tissue infection (aHR, 1.75; 1.19 to 2.56) and meningitis (aHR, 9.22; 1.77 to 48.10) during periods of active biologic use.

The study was limited by the failure to examine the risk associated with individual drugs, according to researchers.

“Biologic therapy is effective for treatment of moderate-to-severe psoriasis but may be associated with an increased risk for serious infection,” researchers said. “Clinicians should be aware of these potential adverse events when prescribing biologic agents.”

In 2015, results from the Psoriasis Longitudinal Assessment and Registry revealed an elevated risk of serious infections with adalimumab and infliximab compared with nonmethotrexate and nonbiologic therapies. There was no increased risk with ustekinumab or etanercept. [JAMA Dermatol 2015;151:961-9]

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