Comparative risk of serious infections among real-world users of biologics for psoriasis or psoriatic arthritis. Issue 2 (31st October 2019)

• Record Type: Journal Article
• Authors: Li, Xintong; Andersen, Kathleen M; Chang, Hsien-Yen; Curtis, Jeffrey R; Alexander, G Caleb
• Is Part Of: Annals of the rheumatic diseases. Volume 79:Issue 2(2020)
• Page Start: 285
• Page End: 291
• Publication Date: 2019-10-31
• Subjects: interleukin inhibitors -- tumor necrosis factor alpha -- psoriasis -- psoriatic arthritis -- serious infections; Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2019-216102
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Objective: To examine whether initiation of interleukin (IL)-17, IL-12/23 or tumour necrosis factor (TNF) inhibitor is associated with an increased risk of serious infection among real-world psoriasis (PsO) or psoriatic arthritis (PsA) patients. Methods: We assembled a retrospective cohort of commercially insured adults in the USA diagnosed with PsO or PsA between 2015 and 2018. Exposure was dispensation for IL-17 (ixekizumab or secukinumab), IL-12/23 (ustekinumab) or TNF (adalimumab, certolizumab pegol, etanercept, golimumab and infliximab). The outcome was infection requiring hospitalisation after biologic initiation. Incidence rates (IRs) per 100 person-years were computed, and hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models, adjusted for inverse probability of treatment-weighted propensity scores. Results: A total of 11 560 new treatment episodes were included. Overall, 190 serious infections (2% of treatment episodes) were identified in 9264 person-years of follow-up. Class-specific IRs were similar among IL-17 and TNF, yet significantly lower for IL-12/23. After adjustment for propensity scores, there was no increased risk with IL-17 compared with either TNF (HR=0.89, 95% CI 0.48 to 1.66) or IL-12/23 (HR=1.12, 95% CI 0.62 to 2.03). By contrast, IL-23/23 were associated with a lower risk of infections than TNF (HR=0.59, 95% CI 0.39 to 0.90). Conclusions: Relative to TNF and IL-17, IL-12/23 inhibitors were associated with a reduced risk of serious infection in biologic-naïve patients with PsO or PsA. In biologic-experienced individuals, there was no difference in infection risk across TNF, IL-17 or IL-12/23 inhibitors.